Readmissions to hospital
If health improving management of patients for whom care is costly is
an important strategy, for better health outcomes and controlling health
care expenditures, in developed countries, (1) this aim is crucial for
National Health Systems –with universal and equity services for all-in
poor countries, with scarce resources, as Cuba is.
Our group reviewed 1 442 medical records of patients who were admitted to
Internal Medicina and Geriatrics Departments at the Hospital Dr. Gustavo
Aldereguía Lima, Cienfuegos, Cuba, since January to April 2001. (2) In
this period, 43 patients fulfilled the criteria of readmissions (for this
study we selected cases with a previous discharge from our hospital, four
months before or less). Readmissions represented 3% of all patients.
Analysing the main characteristics of this group, we found that the mean
age was high (63.3 years), and the great majority of them were suffering
underlying Chronic Non Communicable Diseases: respiratory diseases
(39.3%), heart failure (34.8%) and neoplasms (11.6%). The first cause of
hospitalization was an acute exacerbation of their chronic conditions
(67.4%). Slighty higher rates of alcoholics (9.2%) and smokers (44.2%)
were reported in this group, when we compared them with those without
readmissions. Only a small proportion (16.2%) referred difficulties for
primary care follow up before their admissions. Other common outcome
indicators of institutional efficiency –as mean hospital stay and
mortality rates- did not differ of the rest of the patients.
Therefore, we welcome the research of Billings, Dixon, Mijanovich,
Wennberg as a good intent to develop a method of identifying patients at
high risk of readmissions to hospital, not only to control health care
expenditures but mainly to achieve better health care for them. (3)
Iris González-Morale MD,
María C. Fragoso-Marchante MD,
Alfredo A. Espinosa-Roca MD,
Yenisei Quintero-Méndez MD,
Alfredo D. Espinosa Brito MD, PhD
Internal Medicine Department
Hospital Dr. Gustavo Aldereguía Lima
1. Department of Health. Supporting people with long term conditions: an
NHS and social care model to support local innovation and integration.
London: Department of Health, 2005 (available at:
2. Espinosa-Roca AA, Espinosa-Brito AD, Quintero-Méndez Y. Pacientes
reingresados en el hospital. Servicios de Medicina Interna y Geriatría.
Enero-abril 2001. Cienfuegos: Hospital Dr. Gustavo Aldereguía Lima, 2001.
3. Billings J, Dixon J, Mijanovich T, Wennberg D. Case finding for
patients at risk of readmission to hospital: development of algorithm to
identify high risk patients. BMJ 2006;333:327-30.
Competing interests: No competing interests