An unplanned readmission score measures healthcare quality by reflecting a hospital’s performance in patient care after discharge. This metric assesses how often patients return to the hospital unexpectedly following an initial stay. Analyzing these scores helps healthcare systems identify areas for improvement in their services and patient transitions.
Understanding Unplanned Readmissions
An unplanned readmission occurs when a patient returns to the hospital for unscheduled care within a specific timeframe after being discharged from an earlier hospitalization. This differs from planned readmissions, such as a scheduled follow-up surgery or a routine chemotherapy session. For example, a patient returning with a surgical wound infection two weeks after their initial surgery would be considered an unplanned readmission.
Healthcare systems closely monitor these events because they can signal potential gaps in the initial care provided or issues with discharge planning. The typical timeframe for tracking readmissions is within 30 days of discharge, although some definitions may extend to 31 days or use a shorter 28-day period. A high rate of unplanned readmissions can suggest that patients are not receiving adequate instructions, experiencing complications, or facing difficulties transitioning to home or other care settings.
How the Score is Determined
Calculating an unplanned readmission score involves various patient and hospital factors. Data points collected include patient demographics, specific diagnoses, and procedures performed during the initial hospital stay. For instance, the Centers for Medicare & Medicaid Services (CMS) tracks hospital-wide all-cause unplanned readmissions within 30 days of discharge for Medicare fee-for-service beneficiaries aged 65 and older.
Risk adjustment is a key part of determining the score, accounting for differences in patient populations across hospitals to ensure fair comparisons. This adjustment considers factors like a patient’s age, sex, and pre-existing medical conditions (comorbidities) that might increase their likelihood of readmission.
For example, a hospital treating a sicker patient population with more complex conditions would have its readmission rates adjusted to reflect these inherent risks, preventing unfair penalties. The score may be presented as an “excess readmission ratio” (ERR), comparing a hospital’s predicted readmission rate to its expected rate.
Impact on Patients and Hospitals
High unplanned readmission scores affect both patients and healthcare facilities. For patients, an unexpected return to the hospital can lead to negative health outcomes, including increased risk of healthcare-associated infections, heightened stress, and disruption of daily life. It also often results in additional out-of-pocket expenses, such as co-payments and deductibles, adding to their financial burden.
Hospitals with elevated unplanned readmission rates face significant challenges. Government programs, such as Medicare’s Hospital Readmission Reduction Program (HRRP), impose financial penalties on hospitals whose readmission rates exceed expected averages. These penalties, which can be up to 3% of Medicare payments, incentivize hospitals to improve care coordination and reduce avoidable readmissions. Beyond financial repercussions, high readmission scores can damage a hospital’s reputation, lead to lower public quality ratings, and strain operational efficiency due to increased demand on resources like beds and staff.
Strategies to Improve Scores
Hospitals and healthcare providers employ various strategies to reduce unplanned readmissions and improve their scores. A primary focus is enhancing discharge planning, which includes thorough medication reconciliation to prevent errors and ensure patients understand their regimen. Providing clear, actionable follow-up instructions and confirming patient understanding through methods like “teach-back” can reduce readmissions by as much as 45%.
Post-discharge patient follow-up is another effective approach, often involving phone calls or home visits to monitor recovery and address emerging issues. Studies suggest that patients contacted within 14 days of discharge may experience a 20% reduction in readmissions, particularly those with multiple chronic conditions.
Care coordination across different healthcare settings, such as primary care and specialists, ensures a seamless transition for patients from hospital to home. Leveraging technology, including telehealth for remote monitoring and virtual consultations, also aids in supporting patients after discharge and can reduce readmission rates for certain conditions like heart failure.