Preventability of Early Versus Late Hospital Readmissions

IN RESPONSE:

We direct Dr. Edwards to the sensitivity analysis presented in Table 1 of our article, which uses a more stringent definition of preventability. This analysis resulted in a 16% incidence of preventability and produced a similar difference in preventability between early and late readmissions of 22.6% and 12.5%, respectively.

Dr. Inagaki and colleagues, Dr. Mine and associates, and Drs. Takata and Katoka raised concerns about confounding by factors not included in our analysis. We chose not to include race, functional status, or other inherent patient characteristics because such factors are not taken into consideration when determining readmission penalties, and we wanted to keep these principles consistent. We also did not want to adjust away differences in readmission based on inherent patient characteristics or socioeconomic factors, because doing so implicitly accepts a higher risk for readmission for more vulnerable patients. We believe that the site of care was the most important source of variability and potential confounding and chose to add this factor to our model along with site-specific process-of-care variables. We did add available variables on functional status and initial diagnosis to the model, but neither affected the relationship between readmission timing and preventability or was a significant predictor of preventability. Our data set unfortunately did not include access to an illness severity variable, but our article published in 2015 (1) showed that markers of illness severity were more closely related to early readmissions than late ones.