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For Hospitals, Lowered Death Rates May Not Mean More Readmissions
Date:2/12/2013

ospital within 30 days. And of those hospitalized for pneumonia, 18 percent had to be readmitted.

The average death rate was 11 percent for heart failure, nearly 17 percent for heart attack and 11.5 percent for people with pneumonia, according to the study.

When they compared these two measures, they found no correlation between heart attack and pneumonia death rates and hospital readmissions. Krumholz said the weak association seen between lower heart failure death rates and higher hospital readmissions was likely due to chance.

Dr. Randall Starling, section head of heart failure in cardiovascular medicine at the Cleveland Clinic in Ohio, pointed out "there is a slight relationship in heart failure patients, but it's not an all-or-nothing relationship; there are plenty of hospitals that do well in both measures."

For heart failure, the study found that 259 hospitals (5.4 percent) were top performers, scoring low on both death and readmission rates. For heart attack, 381 hospitals (8.5 percent) were considered top performers. And for pneumonia, 307 hospitals (6.4 percent) scored low on both death and readmission rates.

Krumholz said the idea "isn't to call out bad hospitals or good hospitals, but to determine how we can drive everyone toward better performance."

Starling said that part of the problem is that no one has come up with a precise formula on how to identify the patients at highest risk of readmission.

He said that his hospital and others are focusing on the transition from hospital to home, or to a skilled nursing or rehabilitation facility. "It's an extremely important transition, and an opportunity to improve communications," said Starling. He said that patients should receive follow-up phone calls, and they should have an appointment with their primary care provider scheduled before they leave the hospital. "It's important to provide a continuum of care," said Starling.

Krumholz agreed that the tra
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