The newest Dartmouth Atlas report, released Sept. 28, documents striking variation in 30-day hospital readmission rates for Medicare patients across 308 hospital-referral regions.1 The authors found little progress in decreasing 30-day readmissions from 2004 to 2009, while for some conditions and many regions, rates actually went up.
National readmission rates following surgery were 12.7% in both 2004 and 2009; readmissions for medical conditions rose slightly, from 15.9% to 16.1%, over the same period. Only 42% of hospitalized Medicare patients discharged to home had a PCP contact within 14 days of discharge, according to the report.
The Dartmouth Atlas Project (www.dartmouthatlas.org) documents geographic variation in healthcare utilization unrelated to outcome. It offers an extensive database for comparison by state, county, region and facility.
The new report is the first to identify an association nationally between readmissions rates and “the overall intensity of inpatient care provided to patients within a region or hospital,” with patterns of relatively high hospital utilization often corresponding with areas of higher readmissions. “Other patients are readmitted simply because they live in a locale where the hospital is used more frequently as a site of care,” the authors note.
Without continuous, high-quality care coordination across sites, the authors write, discharged patients can repeatedly bounce back to emergency rooms and hospitals.
