Readmission to hospital: a measure of quality or outcome?
- Correspondence to: A Clarke Institute of Community Health Sciences, Queen Mary, Barts and the London School of Medicine and Dentistry, London E1 4NS;
The value of readmission to hospital as a quality indicator is still debatable
Readmission to hospital has often been considered as a possible measure of quality of hospital care. Although its measurement is not always easy, the concept is beguilingly simple. An information manager in health services once described it like this: “I take my car into the garage; if it needs to go back in a short time then that’s obviously because they didn’t do a good enough job!” At the individual level, undoubtedly readmission can represent a failure or breakdown in plans of care for a particular patient, or the occurrence of an unexpected adverse outcome—for example, readmission for wound infection or deep venous thrombosis after surgery. However, as might be expected, health care is almost always more complicated than this.
A number of factors unrelated to the quality of hospital care can affect the likelihood of readmission.1 Patient factors are important, such as the severity, predictability and chronicity of the underlying condition, or levels of comorbidity or social support. Many hospital factors are known to affect the likelihood of a hospital admission (and therefore the likelihood of re-admission) including the proximity of the hospital, the availability of hospital beds, and the availability of intermediate or “step down facilities”. The planning of care pathways can also affect the likelihood of …