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Study: No link between hospital deaths and readmissions

February 13, 2013
by Patricia Sheehan, Editor-in-Chief
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A measure used by Medicare that penalizes hospitals for poor performance is not related to how many patients die after admittance, according to a new study.

The study, published Tuesday in The Journal of the American Medical Association, suggests that there’s no link between hospitals with high readmissions and those with low mortality rates.

Researchers found no relationship between readmissions and mortality rates for Medicare patients who experienced heart attacks or pneumonia between 2005 and 2008. According to a Kaiser Health News (KHN) report, the study did find a "modest" inverse relationship between readmissions and death rates for heart failure patients, where hospitals with low death rates tended to have somewhat higher readmission rates.

"I feel we've dispelled the notion that your performance in mortality will dictate your performance in readmission," said Dr. Harlan Krumholz of Yale University School of Medicine, the lead author of the study, in the KHN report. "This result says they appear to be measuring different things, they're not strongly related to each other and you can clearly do well on both."

The study has not stopped the debate among researchers, including ones from the Cleveland Clinic, who previously suggested that higher readmission rates might be the consequence of successful care.

Dr. Bruce Lytle, chairman of The Cleveland Clinic's heart and vascular programs, told KHN he considered the Krumholz's finding about heart failure readmissions more significant than Krumholz gave it credit for. "He got very similar results from what we noted," Lytle said. "He tends to feel it's not a big inverse association. But big and small are a matter of interpretation."

Dr. Ashish Jha, a professor at the Harvard School of Public Health who has written skeptically about the readmission measure, told KHN that Krumholz’s analysis strengthened his concerns that readmissions are not a trustworthy way to gauge the quality of hospitals.

Jha said that most hospital quality measures tend to move in tandem: for instance a hospital that frequently follows the appropriate methods of care also tends to do well in keeping patients alive. But Jha said Krumholz's study showed there was no connection between hospitals that do well on keeping patients alive and keeping them from returning.

"This paper offers strong evidence that readmissions is not a good measure of the quality of hospital care," Jha said, in the KHN report. "It may be a good way to promote greater accountability for what happens to patients after they leave. But, as a measure of hospital quality, not as much."

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