and the elephant in the room not mentioned by media or Obama is tremendous profit gouging of health care industries. but never brought up in plans to make health care truly reformed.

these guys can’t serve 2 masters. so the corporatists are the shadow masters, and the spin is on to convince us as consumers they are doing their best for us. Where’s Ralph N. when you need him.

My thought was more along the lines of a patient with a poorly controlled condition or who is not compliant with their treatment. Take such a patient with diabetes, COPD, or heart failure or even some combination of these. These people can show up repeatedly at a hospital, be worth admitting, need hospital level of care, get stabilized, get cut loose, and reappear in a few days or a few weeks. They can receive the best care in the world and it still won’t make much of a difference on whether they will need to be readmitted. I said to you in an earlier thread I believe that 1/3 of patients are non-compliant so this is a pretty significant issue, not just one or two on the margins.

The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence
Ashton CM, Del Junco DJ, Souchek J, Wray NP, Mansyur CL.
Medical Care. 1997 Oct;35(10):1044-59.

OBJECTIVES: To help resolve the current controversy over the validity of early readmission as an indicator of the quality of care, the authors critically reviewed the literature using meta-analysis to derive summary estimates of effect and evaluate inter-study heterogeneity. METHODS: The authors selected reports meeting five criteria: (1) presentation of new data on medical-surgical hospitalization of adults; (2) measurement of outcome as a person-specific readmission; (3) readmission within less than or equal to 31 days; (4) examination of some aspect of the process of inpatient care; (5) inclusion of a comparison group. One meta-analysis examined 13 comparisons of readmission rates after substandard versus normative care, another examined 9 comparisons of readmission rates after normative versus exceptional care, and the third examined all 22 comparisons together. Two authors applied inclusion criteria and extracted data on methods and findings. Two others classified studies on 11 methodological variables for the heterogeneity evaluation. RESULTS: The summary odds ratio for readmission after substandard care was 1.24 (0.99-1.57) relative to normative care; for readmission after normative care the summary odds ratio was 1.45 (0.90-2.33) relative to exceptional care. The individual odds ratios varied significantly (chi2, 21 df equal to 50.34, P equal to 0.0003). Most of the variance in study odds ratios could be explained by whether the study focused on the quality of patient care or the qualifications of patient care providers. The summary odds ratio for the 16 homogeneous comparisons focusing on the quality of patient care was 1.55 (1.25-1.92). CONCLUSIONS: Early readmission is significantly associated with the process of inpatient care. The risk of early readmission is increased by 55% when care is of relatively low quality, that is, substandard or normative instead of normative or exceptional.

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“Readmission to the hospital within a few days or weeks of discharge is a common and costly occurrence. Depending on diagnosis, 5% to 30% of adult medical-surgical patients are readmitted within a month.”

(added in edit: a good study will break down readmits into planned vs. unplanned, and look at stats by age and gender and diagnoses. I don’t have time to look into this right now in detail, but I would hope for US studies, any Medicare issues were taken into account)

OBJECTIVES: To help resolve the current controversy over the validity of early readmission as an indicator of the quality of care, the authors critically reviewed the literature using meta-analysis to derive summary estimates of effect and evaluate inter-study heterogeneity. METHODS: The authors selected reports meeting five criteria: (1) presentation of new data on medical-surgical hospitalization of adults; (2) measurement of outcome as a person-specific readmission; (3) readmission within
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“Readmission to the hospital within a few days or weeks of discharge is a common and costly occurrence. Depending on diagnosis, 5% to 30% of adult medical-surgical patients are readmitted within a month.” (in edit: I think this is range for US hospitals)

Simply put, a Medicare beneficiary is eligible for the extended care benefit only if he or she has been an inpatient in an acute care hospital for 3 consecutive calendar days. The days are counted by the number of days the patient is on the midnight census.

http://www.nursingcenter.com/p…..tid=765774

Basically, if you can keep a patient in the hospital per the “3 midnight” rule, they are eligible for the extended care benefit once they leave. This is a rule that can place physicians in conflict with hospitals. The hospital gets the same payment per the DRG whether it is a one day or 3 day stay (my understanding) so they have an incentive to discharge the patient as soon as possible. The physician on the other hand may try to keep the patient in the hospital so that he/she can qualify for the benefit, i.e. access to skilled nursing which the physician feels is needed. Hope this helps.