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PLoS One. 2014 Mar 11;9(3):e91244. doi: 10.1371/journal.pone.0091244. eCollection 2014.

Readmissions at a public safety net hospital.

Author information

1
Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America; Department of Medicine, Hawaii Permanente Medical Group, Wailuku, Hawaii, United States of America; Department of Medicine, Maui Memorial Medical Center, Wailuku, Hawaii, United States of America.
2
Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America; David Geffen School of Medicine at University of California at Los Angeles (UCLA), Los Angeles, California, United States of America.
3
David Geffen School of Medicine at University of California at Los Angeles (UCLA), Los Angeles, California, United States of America; Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.
4
Department of Medicine, Maui Memorial Medical Center, Wailuku, Hawaii, United States of America.
5
Department of Quality, Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.
6
Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.

Abstract

OBJECTIVE:

We aimed to determine factors related to avoidability of 30-day readmissions at our public, safety net hospital in the United States (US).

METHODS:

We prospectively reviewed medical records of adult internal medicine patients with scheduled and unscheduled 30-day readmissions. We also interviewed patients if they were available. An independent panel used pre-specified, objective criteria to adjudicate potential avoidability.

RESULTS:

Of 153 readmissions evaluated, 68% were unscheduled. Among these, 67% were unavoidable, primarily due to disease progression and development of new diagnoses. Scheduled readmissions accounted for 32% of readmissions and most (69%) were clinically appropriate and unavoidable. The scheduled but avoidable readmissions (31%) were attributed largely to limited resources in our healthcare system.

CONCLUSIONS:

Most readmissions at our public, safety net hospital were unavoidable, even among our unscheduled readmissions. Surprisingly, one-third of our overall readmissions were scheduled, the majority reflecting appropriate management strategies designed to reduce unnecessary hospital days. The scheduled but avoidable readmissions were due to constrained access to non-emergent, expensive procedures that are typically not reimbursed given our system's payor mix, a problem which likely plague other safety net systems. These findings suggest that readmissions do not necessarily reflect inadequate medical care, may reflect resource constraints that are unlikely to be addressable in systems caring for a large burden of uninsured patients, and merit individualized review.

PMID:
24618829
PMCID:
PMC3949745
DOI:
10.1371/journal.pone.0091244
[Indexed for MEDLINE]
Free PMC Article
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