Preventing Readmissions: Should We Be Looking at the Hospital Exit or the Entrance?

Initiatives to lower rehospitalizations have focused on discharge planning and transitional care to optimize outcomes and lower costs; however, broad-based effects of these efforts have been underwhelming. What has not been examined is the extent to which readmission rates are explained by other factors, including initial hospitalization rates.

Researchers used Medicare data to identify patients admitted in a 6-month period in 2008 for congestive heart failure (CHF) or pneumonia. On the basis of their residence zip codes, patients were assigned to hospital referral regions (HRRs). Investigators stratified HRRs by readmission rates and examined the contribution of four factors in explaining the variation among HRR quartiles:

• Hospitalization ra…