A large number of 30-day readmissions are not caused by poor-quality care but are instead related to mental health, substance abuse or homelessness, according to a study published in JAMA Surgery.
Researchers in Seattle examined one year's worth of readmissions data from a Level I trauma center and safety-net hospital. Among 2,100 discharges, 173 patients were readmitted to the hospital.
Almost one-third of those readmissions fell into two groups: injection drug users who were readmitted for infections at new sites (29 patients, or 17 percent of readmissions) and people with lack of adequate social support, leading to issues around discharge and follow-up process (25 patients, or 14.5 percent of readmissions).
Other causes of readmission were:
- Infections not detectable during index readmission (23 patients, 13 percent)
- Illness related to injury or condition (16 patients, 9 percent)
- Preventable complication of care (16 patients, 9 percent)
- Deterioration of medical conditions (two patients, 1 percent)
"Many cases of readmissions may truly be unavoidable in current paradigms of care because we found socially fragile populations to be at as high risk as those that are medically fragile," the study authors wrote. "A large number of readmissions were not owing to suboptimal medical care delivered at the index admission…but many were owing to confounding issues of mental health, substance abuse or homelessness, issues that require more intense in-hospital and postdischarge social support than most hospitals…can currently provide."
This isn't the first study that has called the usefulness of using readmissions as a quality metric into question. For instance, research published last fall in JAMA Internal Medicine noted that penalties in the Hospital Readmission Reduction Program unfairly punish hospitals that provide care for more vulnerable patients.
"Perhaps with yet another article questioning the role of 30-day readmissions, we should focus our attention on finding better markers of surgical quality," two physicians wrote in invited commentary in JAMA Surgery.