Luke O. Hansen, MD, MHS; Mark V. Williams, MD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1422.
Hansen L., Williams M.; Reducing 30-Day Rehospitalization. Ann Intern Med. 2012;156:252. doi: 10.7326/0003-4819-156-3-201202070-00027
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Published: Ann Intern Med. 2012;156(3):252.
We agree with Dr. Sandy that thoughtful attention to care transitions will often result in lower readmission rates, with process change supported by some of the interventions we reviewed as well as a culture shift to more safety awareness at discharge. However, these improvements are unlikely to be experienced by all hospitals. The key question for performance-based reimbursement tied to the readmission outcome is whether hospitals that demonstrate themselves to be laggards fall short because of factors that are or are not under their control.
Many of the reports of success are observational, and we lack a robust evidence base of randomized, controlled trials. We believe that the hospital discharge transition is an event for which appropriate randomized, controlled trials could be conducted, but research funding has been lacking. In addition, because peer-reviewed literature is predominantly focused on the academic health care environment, we cannot be confident that nonacademic sites of care—where most health care in the United States is delivered—can expect similar benefits from interventions. The importance of organizational context to organizational change raises concerns that many hospitals will be frustrated if they seek improvement by replicating the processes we reviewed.
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