Poor Primary Care Access Raises Readmission Odds

A patient’s hospital readmission likelihood relies more heavily on community factors than care at discharge, according to a study published in Health Services Research.

The community factors, which are often unrelated to a hospital’s operations, include access to and quality of community-based care, the researchers found. In fact, only 42% of the variation in pooled hospital readmission rates can be tied to individual hospital performance, they continued.

“That the majority of unexplained variation in hospital readmission rates can be attributed to counties rather than hospitals suggests that narrowly targeting hospitals with reimbursement adjustments and other incentives can lead, at best, to marginal improvements in readmission rates,” the authors wrote. “More effective policies might be directed at the wider system of care, including primary care and nursing home quality.”

Researchers analyzed risk-standardized 30-day readmission rates from July 1, 2007, to June 30, 2010, among patients with acute myocardial infarction, heart failure, and pneumonia. They compared these results against hospital and county data from the 2010 American Hospital Association Annual Survey database, the 2010 Health Resources and Services Administration’s Area Resource File, and the 2010 Nielsen PopFacts dataset.

The final sample included 4073 hospitals located in 2254 counties throughout the nation.

Several demographic factors—including proportion of the population who were never married, number of Medicare beneficiaries per capita, and low education status—were associated with higher readmission rates. However, rural areas and high concentrations of retirement areas were associated with lower readmission rates.

Greater numbers of general practitioners and more nursing homes per capita were also associated with lower readmission rates, while more specialist physicians and more hospital beds per capita were associated with higher readmission rates, researchers found.

“The number of general practitioners per capita is a measure of access to primary care; patients who are discharged into areas with smaller numbers of general practitioners may have fewer options other than returning to the hospital following postdischarge events,” the authors noted.