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High Rate of Rehospitalizations Costing Billions
Date:4/1/2009

hink one of the strengths of the Jencks analysis is that he looks at all-cause rehospitalizations, and that's a unique and a new view," said Dr. Amy Boutwell, a general internist at Newton-Wellesley Hospital in Newton, Mass., and director of the Institute for Healthcare Improvement's reducing rehospitalizations initiative.

For the study, researchers analyzed Medicare claims data from October 2003 through December 2004. The study included information on almost 12 million patients discharged from a hospital during that time.

Overall, the data showed that the risk of rehospitalization persists over time. About two in every three Medicare beneficiaries (62.9 percent) discharged from the hospital were readmitted or died within a year.

The study also revealed wide geographic disparities in rates of rehospitalization within 30 days of discharge -- from a low of 13.3 percent in Idaho to a high of 23.2 percent in Washington, D.C.

Often, the people who cycle in and out of the hospital suffer from multiple medical conditions or psychiatric or social problems, Boutwell said. Someone who relies on an intricate caregiving network -- say, their daughter-in-law, their neighbor and a church member -- can get into trouble when that social safety net breaks down, she explained.

"We have a short-hand nickname for them. We call them 'bounce-backs' or frequent fliers," Boutwell said. "And although that's not a very sensitive term, I think it reflects the fact that throughout the medical profession we implicitly recognize that there is this group of patients who are in and out of the hospital with quite high frequency."

But it's not just about being sick and ending up back in the hospital. "It's about traversing from one setting of care to the next setting of care successfully and stably," said Boutwell, who is leading a multi-state initiative to reduce avoidable rehospitalizations.

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