Checking back into the hospital within 30 days of discharge is not only bad news for patients, but also for hospitals, which now face financial penalties for high readmissions. The key to reducing readmissions may be focusing on the whole patient, rather than the specific conditions that caused their hospitalizations, according to a new study by Yale School of Medicine researchers.
Published Nov. 20 in the British Medical Journal, the researchers found that top-performing hospitals those with the lowest 30-day readmission rates had fewer readmissions from all diagnoses and time periods after discharge than lower performing hospitals with higher readmissions.
"Our findings suggest that hospitals may best achieve low rates of readmission by employing strategies that lower readmission risk globally rather than for specific diagnoses or time periods after hospitalization," says lead author Kumar Dharmarajan, MD, a visiting scholar at the Center for Outcomes Research and Evaluation at Yale School of Medicine and cardiology fellow at Columbia University Medical Center.
Despite the increased national focus on reducing hospital readmissions, Dharmarajan said it had not been clear whether hospitals with the lowest readmission rates have been especially good at reducing readmissions from specific diagnoses and time periods after hospitalization, or have instead lowered readmissions more generally. To find out, Dharmarajan and colleagues studied more than 4,000 hospitals in the United States caring for older patients hospitalized with heart attacks, heart failure, or pneumonia from 2007 through 2009. The authors examined over 600,000 readmissions occurring within 30 days of hospitalization.
The research team found that readmission diagnoses and timing were similar regardless of a hospital's 30-day readmission rates. High-performing hospitals had fewer readmissions across all diagnostic categories and time periods after discharge. "Earlier data show that patients are readmitted for a broad range of conditions. We have found empirically that hospitals with the lowest readmission rates have reduced readmissions across the board," says Dharmarajan.
"This study suggests that the path to excellence in readmission is a result of an approach that focuses on the patient as a whole rather than on what caused them to be admitted," says senior author and director of the Yale Center for Outcomes Research and Evaluation Harlan Krumholz, MD, the Harold H. Hines, Jr. Professor of Medicine and professor of investigative medicine and of public health at Yale School of Medicine. "And this study adds emphasis to the idea that patients are susceptible to a wide range of conditions after a hospitalization they are a highly vulnerable population and we need to focus intently on making the immediate post-discharge period safer."
Other authors on the study include Angela F. Hsieh, Zhenqiu Lin, Héctor Bueno, Joseph S. Ross, Leora I. Horwitz, José Augusto Barreto-Filho, Nancy Kim, Lisa G. Suter, Susannah M. Bernheim, and Elizabeth E. Drye.
The study was funded by grants 1U01HL105270-02 and T32HL007854 from the National Heart, Lung, and Blood Institute.
Source: Yale School of MedicineÂ
I Was There: An Infection Preventionist on the COVID-19 Pandemic
April 30th 2025Deep feelings run strong about the COVID-19 pandemic, and some beautiful art has come out of those emotions. Infection Control Today is proud to share this poem by Carmen Duke, MPH, CIC, in response to a recent article by Heather Stoltzfus, MPH, RN, CIC.
From the Derby to the Decontam Room: Leadership Lessons for Sterile Processing
April 27th 2025Elizabeth (Betty) Casey, MSN, RN, CNOR, CRCST, CHL, is the SVP of Operations and Chief Nursing Officer at Surgical Solutions in Overland, Kansas. This SPD leader reframes preparation, unpredictability, and teamwork by comparing surgical services to the Kentucky Derby to reenergize sterile processing professionals and inspire systemic change.
Show, Tell, Teach: Elevating EVS Training Through Cognitive Science and Performance Coaching
April 25th 2025Training EVS workers for hygiene excellence demands more than manuals—it requires active engagement, motor skills coaching, and teach-back techniques to reduce HAIs and improve patient outcomes.