Hospital Readmissions

Reducing preventable hospital readmissions is a national priority for payers, providers, and policymakers seeking to improve health care and lower costs. In 2012, the Centers for Medicare & Medicaid Services began reducing Medicare payments for certain hospitals with excess 30-day readmissions for patients with several conditions:

  • Heart attack,
  • Heart failure,
  • Pneumonia,
  • Chronic obstructive pulmonary disease,
  • Hip or knee replacement, and
  • Coronary artery bypass graft surgery.

Hospitals are taking many steps to lower the rate of readmissions, including—

  • Focusing on better coordination of care and communications between providers and patients and their caregivers;
  • Improving discharge planning, education, and followup for discharged patients; and
  • Using electronic medical records to share information and provide continuity of care.

AHRQ has tools, data, and research to help hospitals reduce preventable readmissions.

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Tools

Re-Engineered Discharge (RED) Toolkit
AHRQ contracted with Boston University Medical Center to develop this toolkit to assist hospitals, particularly those that serve diverse populations, to re-engineer their discharge process.

Taking Care of Myself: A Guide for When I Leave the Hospital
This easy-to-read guide is for patients to use at discharge to help them track medication schedules, upcoming medical appointments, and important phone numbers.

Designing and Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions
This guide provides evidence-based strategies to reduce readmissions and can be adapted or expanded to address the transitional care needs of the adult Medicaid population.

Project BOOST (Better Outcomes for Older Adults through Safer Transitions)
Project BOOST offers a discharge bundle consisting of medication reconciliation forms, a checklist for patient-centered hospital discharge education, and a checklist for postdischarge continuity checks.

Data

Nationwide Readmissions Database
The Nationwide Readmissions Database (NRD) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization Project. NRD supports various analyses of national readmission rates for all payers and uninsured patients and addresses a large gap in health care data: the lack of nationally representative information on hospital readmissions for all ages. Unweighted, this database contains data from approximately 15 million discharges each year. Weighted, it estimates roughly 35 million discharges.

Research

Healthcare Cost and Utilization Project
The Healthcare Cost and Utilization Project provides statistical briefs that cover conditions with the largest number of adult hospital readmissions and readmissions to U.S. hospitals by procedure and diagnosis.

Readmissions and Adverse Events After Discharge
This Patient Safety Primer from AHRQ’s Patient Safety Network discusses the causes of preventable readmissions and ways to prevent them.

Health IT Projects on Readmissions
The Health IT program website shares projects that use technology to reduce readmissions.

Reducing Unnecessary Hospital Readmissions: The Role of the Patient Safety Organization
Patient Safety Organizations help hospitals with high readmission rates improve their performance.