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A conceptual framework for the study of early readmission as an indicator of quality of care

Author

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  • Ashton, Carol M.
  • Wray, Nelda P.

Abstract

Despite the perennial popularity of readmission as an indicator of the quality of hospital care, the empiric evidence linking it to process-of-care problems during the prior hospitalization is inconsistent. We devised a conceptual model for the use of unscheduled readmission within 31 days as an indicator of the quality of medical-surgical inpatient care for adults, and then conducted a systematic review of the readmission literature to determine the extent to which the evidence supports the proposed relationships. A fairly complex web of relationships influences the association between the process of inpatient care and early readmission. From the evidence to date, it is impossible to say with confidence that early readmission is or is not a valid and useful quality indicator. In most negative studies, the absence of an association appears to be explainable on the basis of improper study design, omission of important variables, or mis-specification of variables. Variables intervening between or confounding the relationship of the process of inpatient care to early readmission have received inadequate attention in past work. Investigators can use the proposed model and literature review to ensure their work advances the field and puts the hypothesis that early readmission is a valid quality indicator to a rigorous test. This matter has a certain urgency in view of the vast amount of resources that providers and payers devote to monitoring readmission rates and reviewing readmissions.

Suggested Citation

  • Ashton, Carol M. & Wray, Nelda P., 1996. "A conceptual framework for the study of early readmission as an indicator of quality of care," Social Science & Medicine, Elsevier, vol. 43(11), pages 1533-1541, December.
  • Handle: RePEc:eee:socmed:v:43:y:1996:i:11:p:1533-1541
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    Citations

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    Cited by:

    1. Han, Kyu-Tae & Lee, Hyo Jung & Park, Eun-Cheol & Kim, Woorim & Jang, Sung-In & Kim, Tae Hyun, 2016. "Length of stay and readmission in lumbar intervertebral disc disorder inpatients by hospital characteristics and volumes," Health Policy, Elsevier, vol. 120(9), pages 1008-1016.
    2. Mascia, Daniele & Angeli, Federica & Di Vincenzo, Fausto, 2015. "Effect of hospital referral networks on patient readmissions," Social Science & Medicine, Elsevier, vol. 132(C), pages 113-121.
    3. Chia-Hsuan Wu & Ching-Cheng Chang & Po-Chi Chen & Ken-Nan Kuo, 2013. "Efficiency and productivity change in Taiwan’s hospitals: a non-radial quality-adjusted measurement," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 21(2), pages 431-453, March.
    4. Haomiao Li & Yingchun Chen & Hongxia Gao & Jingjing Chang & Dai Su & Shihan Lei & Di Jiang & Xiaomei Hu & Min Tan & Zhifang Chen, 2019. "Effect of an Integrated Payment System on the Direct Economic Burden and Readmission of Rural Cerebral Infarction Inpatients: Evidence from Anhui, China," IJERPH, MDPI, vol. 16(9), pages 1-12, May.
    5. Westert, Gert P. & Lagoe, Ronald J. & Keskimaki, Ilmo & Leyland, Alastair & Murphy, Mark, 2002. "An international study of hospital readmissions and related utilization in Europe and the USA," Health Policy, Elsevier, vol. 61(3), pages 269-278, September.
    6. Min Chen, 2018. "Reducing excess hospital readmissions: Does destination matter?," International Journal of Health Economics and Management, Springer, vol. 18(1), pages 67-82, March.
    7. Ben-Assuli, Ofir, 2015. "Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments," Health Policy, Elsevier, vol. 119(3), pages 287-297.
    8. Maurice L. Moffett & Alok Bohara, 2005. "Hospital Quality Oversight by the Joint Commission on the Accreditation of Healthcare Organizations," Eastern Economic Journal, Eastern Economic Association, vol. 31(4), pages 629-647, Fall.

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