Jiann-Ping Hsu College of Public Health, Georgia Southern University Hendricks Hall, PO Box 8015, Statesboro, GA 30460-8015, USA.
Implement Sci. 2010 Nov 17;5:88. doi: 10.1186/1748-5908-5-88.
Hospital readmissions are a leading topic of healthcare policy and practice reform because they are common, costly, and potentially avoidable events. Hospitals face the prospect of reduced or eliminated reimbursement for an increasing number of preventable readmissions under nationwide cost savings and quality improvement efforts. To meet the current changes and future expectations, organizations are looking for potential strategies to reduce readmissions. We undertook a systematic review of the literature to determine what factors are associated with preventable readmissions.
We conducted a review of the English language medicine, health, and health services research literature (2000 to 2009) for research studies dealing with unplanned, avoidable, preventable, or early readmissions. Each of these modifying terms was included in keyword searches of readmissions or rehospitalizations in Medline, ISI, CINAHL, The Cochrane Library, ProQuest Health Management, and PAIS International. Results were limited to US adult populations.
The review included 37 studies with significant variation in index conditions, readmitting conditions, timeframe, and terminology. Studies of cardiovascular-related readmissions were most common, followed by all cause readmissions, other surgical procedures, and other specific-conditions. Patient-level indicators of general ill health or complexity were the commonly identified risk factors. While more than one study demonstrated preventable readmissions vary by hospital, identification of many specific organizational level characteristics was lacking.
The current literature on preventable readmissions in the US contains evidence from a variety of patient populations, geographical locations, healthcare settings, study designs, clinical and theoretical perspectives, and conditions. However, definitional variations, clear gaps, and methodological challenges limit translation of this literature into guidance for the operation and management of healthcare organizations. We recommend that those organizations that propose to reward reductions in preventable readmissions invest in additional research across multiple hospitals in order to fill this serious gap in knowledge of great potential value to payers, providers, and patients.
医院再入院是医疗政策和实践改革的一个主要课题，因为它们是常见的、昂贵的、且潜在可避免的事件。随着全国范围内节约成本和提高质量的努力，医院面临着越来越多的可预防再入院的费用减少或取消的前景。为了应对当前的变化和未来的期望，各组织正在寻找降低再入院率的潜在策略。我们对文献进行了系统回顾，以确定哪些因素与可预防的再入院有关。
我们对英语医学、健康和卫生服务研究文献（2000 年至 2009 年）进行了综述，研究了与非计划性、可避免、可预防或早期再入院相关的研究。这些修饰词中的每一个都被包含在 Medline、ISI、CINAHL、Cochrane 图书馆、ProQuest Health Management 和 PAIS International 中对再入院或再住院的关键字搜索中。结果仅限于美国成年人群体。
该综述包括 37 项研究，这些研究在索引条件、再入院条件、时间框架和术语方面存在显著差异。心血管相关再入院的研究最为常见，其次是所有原因的再入院、其他手术程序和其他特定疾病。患者一般健康状况或复杂性的指标是常见的风险因素。虽然不止一项研究表明，可预防的再入院率因医院而异，但缺乏对许多特定组织层面特征的识别。
目前美国关于可预防再入院的文献包含了来自各种患者群体、地理位置、医疗保健环境、研究设计、临床和理论观点以及疾病的证据。然而，定义上的差异、明显的差距和方法上的挑战限制了将这些文献转化为医疗机构运作和管理的指南。我们建议那些提议奖励减少可预防再入院的组织在多家医院进行更多的研究，以填补对支付者、提供者和患者都具有巨大潜在价值的知识的这一严重差距。
