In the United States, the total cost of readmissions is estimated at more than 25 billion dollars per year. Reducing re-hospitalization rates is a priority challenge for all healthcare systems. By revealing that each day spent in the hospital "increases" the risk of readmission by 2.9%, particularly in rural areas and by detailing the risk factors for readmission, this study conducted in rural Appalachia will to better prevent the risk and reduce the considerable health costs associated with these repeated hospitalizations. The data is presented in the Chest Journal and at the 2018 CHEST Congress annual meeting.
It is indeed one of the savings axes of the American healthcare system, with interventions such as the Hospital Readmission Reduction Program which, within the framework of the Affordable Care Act, penalizes hospitals presenting higher readmission rates. Analysis of data from this specific rural area reveals that health facilities in the region, like many rural areas, have higher readmission rates than the national average. Thus, the hospitals of the "territories" find themselves penalized compared to the large university hospitals.
The study followed 15,500 patients admitted to hospitals in Appalachia from January 2014 to October 2017. The researchers took into account a whole series of variables such as length of stay, age, gender, the "payer" of the health care, month/day/time discharged, smoking or smoking cessation, medication taken upon discharge, and a range of co-morbid diagnoses such as diabetes, hypertension, chronic renal failure, and psychiatric disorders.
The analysis concludes that each day spent in hospital is associated with a 2.0% increase in the risk of readmission: thus, among the significant findings,
- patients discharged more quickly are less likely to be readmitted than those discharged after a prolonged hospital stay;
- patients discharged before 1 p.m. are less likely to be readmitted than those discharged after 1 p.m.;
- former smokers are more likely to be re-admitted than non-smokers and smokers in the process of quitting;
- patients with concurrent diagnosis of COPD, type 2 diabetes, hypertension, psychiatric disorders and chronic renal failure have a higher risk of readmission.
The major factors of readmission to hospital in this rural area appear to be the increase in the duration of hospitalization and smoking. However, the study does not mean that the duration of hospitalization should be reduced at all costs. However, on reading these initial data, it is already possible to better target the prevention of the risk of re-hospitalization, and, in practice, to work on reducing the length of stay, when patients leave before 1 p.m. , smoking cessation in smokers and better monitoring of patients with certain comorbidities.
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