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October 26, 2011

Hospital Readmissions—Not Just a Measure of Quality

Author Affiliations

Author Affiliations: Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (Dr Kangovi); and Robert Wood Johnson Clinical Scholars Program (Dr Kangovi), Division of General Internal Medicine, Perelman School of Medicine (Dr Grande), and Leonard Davis Institute of Health Economics (Drs Kangovi and Grande), University of Pennsylvania, Philadelphia.

JAMA. 2011;306(16):1796-1797. doi:10.1001/jama.2011.1562

Hospital readmissions are common and costly. Policies from the Centers for Medicare & Medicaid Services (CMS) will soon penalize hospitals when its patients are frequently readmitted within 30 days of discharge. As a result, clinicians, health care leaders, and policy makers are searching for ways to reduce readmissions.

The current understanding of what drives readmission focuses on the quality of the inpatient discharge process and on patients' health status (Figure). Health care administrators have relied on this narrow framework to conclude that the best approach to reduce readmission rates is to improve the discharge process for medically high-risk patients. This strategy may yield disappointing results because it misses important factors that contribute to readmission. In this Commentary, we propose a broader framework that can be used to identify alternative strategies to reduce readmissions.

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