Intended for healthcare professionals

Rapid response to:

Research

Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38870.657917.AE (Published 10 August 2006) Cite this as: BMJ 2006;333:327

Rapid Response:

Reducing hospital readmission rates

Sir,

Billings et al are to be congratulated in producing an algorithm
which is predictive of hospital readmission and can identify at risk
groups for targeted intervention. The authors suggest a conservative and
incremental approach to developing appropriate interventions based on
further research with identified 'high risk' individuals. I agree that
such research is necessary, but would suggest that we already know much
that can help and inform service providers and purchasers from existing
evidence.

In a systematic review of discharge arrangements for older people
commissioned by the NHS R&D Health Technology Assessment programme (1),
readmission to acute hospital care was cited as a key undesirable outcome.
Exploration of potential causes for heterogeneity for this outcome
identified 'working across the health and social care interface' as an
important factor in reducing readmission rates after discharge from
inpatient hospital care. In a recent partial update (2), trials that
specifically considered discharge arrangements which were provided in both
the acute and community setting and reported readmission outcomes were
selected for review. The general models of care identified in the review
included comprehensive geriatric assessment, discharge planning, discharge
support and education (but not case management). Conclusions were that
discharge arrangements across the hospital–community interface based on
these general models of care are safe (not associated with increased
mortality or other adverse outcomes) and can reduce hospital readmission
rates by about 20%. This is a worthwhile gain, particularly for older
people at risk of repeated hospital admission which could be achieved
through the adoption of a range of well known, clearly described and
evaluated discharge practices.

The concept of 'working across the hospital community interface'
implies cooperation between health and social care organisations and
professionals providing services in acute and community settings. An
implication is that policies or local practices which create barriers to
co-operation between health and social care, or acute and community
services are unlikely to result in improvements in hospital readmission
rates. Therefore I suggest a simple approach to improving readmission
rates, which does not depend on the generation of new research evidence
would be this: providers and purchasers should critically examine and
increase the extent to which local structures and processes around
hospital discharge encourage effective cooperation between acute and
community health and social care organisations and professionals.

References

1. Parker SG, Peet SM, McPherson AM, Cannaby AM, Abrams K, Baker R,
Wilson A, Lindesay J, Parker G, Jones. DR A systematic review of
discharge arrangements for older people. Health Technology Assessment
2002;6(4).

2. Parker S G. Do current discharge arrangements from inpatient
hospital care for the elderly reduce readmission rates, the length of
inpatient stay or mortality, or improve health status? WHO Health
Evidence Network report 2005. WHO regional office for Europe, Copenhagen.

Competing interests:
None declared

Competing interests: No competing interests

19 August 2006
Stuart G Parker
Professor of Health Care for Older People
Sheffield Institute for Studies on Ageing, University of Sheffield, UK