Less Might Be More for Rehospitalization Rates

Grace C. Huang, MD reviewing Horwitz LI et al. BMJ 2015 Feb 9.

Higher hospital volumes are associated with higher readmission rates.

Higher patient volumes are associated with better surgical outcomes; however, whether this same relation applies to readmission rates is unclear. Investigators used Medicare inpatient claims data from 2010 through 2012 to examine this question. Hospitalizations primarily related to cancer or psychiatric disease and planned readmissions were excluded.

Hospitals were categorized into discharge-volume quintiles (range, 25–173 discharges annually to 2600–25,000 discharges annually). Among almost 7 million admissions at 4651 hospitals, the standardized readmission rates were 14.7% at hospitals in the lowest quintile and 15.9% at hospitals in the highest quintile. A similar pattern was observed when patients were divided into specialty cohorts, with the notable exception of cardiovascular disease, where an inverse association existed (readmission rates, 13.7% at high-volume hospitals vs. 14.6% at low-volume hospitals). The composite outcome of readmission and mortality was not influenced by hospital volume.

CITATION(S):

Horwitz LI et al. Association of hospital volume with readmission rates: A retrospective cross-sectional study. BMJ 2015 Feb 9; 350:h447.