Opportunities and Challenges for Reducing Hospital Revisits
Authors: Kumar Dharmarajan, Harlan M. Krumholz
Journal: Annals of Internal Medicine (2015)

Editorials2 June 2015Opportunities and Challenges for Reducing Hospital RevisitsKumar Dharmarajan, MD, MBA and Harlan M. Krumholz, MD, SMKumar Dharmarajan, MD, MBAFrom Yale School of Medicine, New Haven, Connecticut. and Harlan M. Krumholz, MD, SMFrom Yale School of Medicine, New Haven, Connecticut.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0878 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hospital revisits are common and consequential events for patients. Data from the Medicare population show that almost 1 in 5 older adults is rehospitalized within 30 days of discharge (1). Younger patients are also frequently readmitted at rates that may exceed those of older patients for specific conditions, such as heart failure, diabetes, and selected psychiatric disorders (2). Even in the absence of readmission, an additional 1 in 10 recently discharged patients receives care in an emergency department (ED) as part of a treat-and-release visit (3).Two articles in this issue examine the clinical epidemiology and predictors of 2 types ...References1. Blum J. Statement of Johnathan Blum on delivery system reform: progress report from CMS before the U.S. Senate Finance Committee. 28 February 2013. Accessed at www.finance.senate.gov/imo/media/doc/CMS%20Delivery%20System%20Reform%20Testimony%202.28.13%20%28J.%20Blum%29.pdf on 16 April 2015. Google Scholar2. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project statistical brief no. 153. Rockville, MD: Agency for Healthcare Research and Quality; 2013. Accessed at www.hcup-us.ahrq.gov/reports/statbriefs/sb153.jsp on 16 April 2015. Google Scholar3. Vashi AA, Fox JP, Carr BG, D'Onofrio G, Pines JM, Ross JS, et al. Use of hospital-based acute care among patients recently discharged from the hospital. JAMA. 2013;309:364-71. [PMID: 23340638] doi:10.1001/jama.2012.216219 CrossrefMedlineGoogle Scholar4. Duseja R, Bardach NS, Lin GA, Yazdany J, Dean ML, Clay TH, et al. Revisit rates and associated costs after an emergency department encounter. A multistate analysis. Ann Intern Med. 2015;162:750-56. doi:10.7326/M14-1616 LinkGoogle Scholar5. Nasir K, Lin Z, Bueno H, Normand SL, Drye EE, Keenan PS, et al. Is same-hospital readmission rate a good surrogate for all-hospital readmission rate? Med Care. 2010;48:477-81. [PMID: 20393366] doi:10.1097/MLR.0b013e3181d5fb24 CrossrefMedlineGoogle Scholar6. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309:355-63. [PMID: 23340637] doi:10.1001/jama.2012.216476 CrossrefMedlineGoogle Scholar7. Schuur JD, Baugh CW, Hess EP, Hilton JA, Pines JM, Asplin BR. Critical pathways for post-emergency outpatient diagnosis and treatment: tools to improve the value of emergency care. Acad Emerg Med. 2011;18:e52-63. [PMID: 21676050] doi:10.1111/j.1553-2712.2011.01096.x CrossrefMedlineGoogle Scholar8. Graham KL, Wilker EH, Howell MD, Davis RB, Marcantonio ER. Differences beween early and late readmissions among patients. A cohort study. Ann Intern Med. 2015;162:741-9. doi:10.7326/M14-2159 LinkGoogle Scholar9. Dharmarajan K, Hsieh AF, Kulkarni VT, Lin Z, Ross JS, Horwitz LI, et al. Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study. BMJ. 2015;350:h411. [PMID: 25656852] doi:10.1136/bmj.h411 CrossrefMedlineGoogle Scholar10. Detsky AS, Krumholz HM. Reducing the trauma of hospitalization. JAMA. 2014;311:2169-70. [PMID: 24788549] doi:10.1001/jama.2014.3695 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Yale School of Medicine, New Haven, Connecticut.Disclaimer: The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.Grant Support: By the National Institute on Aging and the American Federation for Aging Research through the Paul B. Beeson Career Development Awards in Aging Research Program (grant K23AG048331-01; Dr. Dharmarajan) and the National Heart, Lung, and Blood Institute (grant 1U01HL105270-05; Center for Cardiovascular Outcomes Research at Yale University [Dr. Krumholz]).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0878.Corresponding Author: Harlan Krumholz, MD, SM, Center for Outcomes Research and Evaluation, 1 Church Street, Suite 200, New Haven, CT 06510; e-mail, harlan.[email protected]edu.Current Author Addresses: Drs. Dharmarajan and Krumholz: Center for Outcomes Research and Evaluation, 1 Church Street, Suite 200, New Haven, CT 06510. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDifferences Between Early and Late Readmissions Among Patients Kelly L. Graham , Elissa H. Wilker , Michael D. Howell , Roger B. Davis , and Edward R. Marcantonio Revisit Rates and Associated Costs After an Emergency Department Encounter Reena Duseja , Naomi S. Bardach , Grace A. Lin , Jinoos Yazdany , Mitzi L. Dean , Theodore H. Clay , W. John Boscardin , and R. Adams Dudley Revisit Rates and Associated Costs After an Emergency Department Encounter Reena Duseja , Naomi S. Bardach , Grace A. Lin , Jinoos Yazdany , Mitzi L. Dean , Theodore H. Clay , W. John Boscardin , and R. Adams Dudley Differences Between Early and Late Readmissions Among Patients Kelly L. Graham , Elissa H. Wilker , Michael D. Howell , Roger B. Davis , and Edward R. Marcantonio Opportunities and Challenges for Reducing Hospital Revisits Kumar Dharmarajan and Harlan M. Krumholz Opportunities and Challenges for Reducing Hospital Revisits Kelly L. Graham , Michael D. Howell , and Edward R. Marcantonio Metrics Cited ByHeart Failure Readmission ReductionAnalysis of Machine Learning Techniques for Heart Failure Readmissions 2 June 2015Volume 162, Issue 11Page: 793-794KeywordsAgingClinical epidemiologyComputed axial tomographyDisclosureHospitalizationsInpatientsPatientsResearch grants ePublished: 2 June 2015 Issue Published: 2 June 2015 CopyrightCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...