Supply-side variables, socioeconomics explain readmission variability more than hospital quality
MONDAY, May 14 (HealthDay News) -- Variation in regional hospital readmission rates for congestive heart failure is due more to the availability of care and socioeconomic factors than hospital performance or patients' degree of illness, according to a study presented at the American Heart Association's Quality of Care & Outcomes Research 2012 Scientific Sessions, held from May 9 to 11 in Atlanta.
Karen E. Joynt, M.D., from Brigham and Women's Hospital in Boston, and colleagues utilized national Medicare data and Dartmouth Atlas data to calculate hospital referral region (HRR)-level readmission rates for congestive heart failure.
The researchers found that readmission rates for congestive heart failure ranged from 10 to 32 percent across communities. Higher readmission rates were seen in HRRs with higher poverty rates, a higher proportion of black patients, more physicians and hospital beds in the community, and a sicker population. After adjustment for confounders, supply-side variables (physician and bed supply in the community) were the most important factor, accounting for 17 percent of the variation between HRRs in the readmission rates for congestive heart failure. Nine percent of the variation was attributable to the socioeconomic characteristics of the community (poverty rate and racial makeup), while differences in hospital quality and case mix accounted for 5 and 4 percent of readmission variation, respectively.
"To really address the readmissions issue, we need to think about this in terms of community and population health," Joynt said in a statement. "Focusing on community-level factors -- such as the supply and mix of physicians and targeting efforts towards poor and minority communities -- may be more fruitful approaches to reducing readmissions. We need to think outside the walls of the hospital."