Reducing Hospital Readmissions2021-12-16T11:45:32-08:00

California’s overall 30-day readmission rate has declined from 14% in 2011 to 13.5% in 2015.1

The rate of unplanned hospital readmissions is an important measure of clinical quality. High rates may indicate concerns with low quality and are associated with high costs.2 Fortunately, there is evidence that hospital readmission rates can be reduced using tested quality improvement methods.3 Typically, these interventions involve system transformation. Coordinating care between in-patient, outpatient, home, and community settings is a key component of high quality health systems.3

Patients’ demographic and economic status, social support structure, and multiple health conditions can increase or decrease the likelihood of being readmitted; though these impacts are not fully understood.

Note that this indicator is not risk-adjusted and differs in some ways from the Centers for Medicaid and Medicare Services (CMS) measure. Data are categorized by age, sex, race/ethnicity, expected payer source, and county of residence. (See metadata below for further details.)

Indicator Progress

In 2016 (baseline year), 14.5% of hospital discharges resulted in unplanned readmissions within 30 days. The most recent data available show 14.9% (2019). We hope to reach a target of 11.9% or lower by 2022.

Note : Due to the transition from ICD-9 to ICD-10 in October 2015, comparisons cannot be made between 2015 (or earlier) and 2016 (or later). The status for this indicator is pending until an ICD-10 trend can be established.

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More Data

Hospital Readmissions

Note: The target has changed from the original LGHC 2012 Task Force Report; see footnote on indicator page.

Baseline

14.5%

Current Rate

14.9%

Target

11.9%

Indicator Highlights

33% spent on hospital care

Approximately 33% of all health care spending in 2009 went to hospital care.2

$25 billion on preventable readmission

An estimated $25 billion is spent on preventable hospital readmissions that result from medical errors and complications, poor discharge procedures, and lack of integrated follow-up care.2

Post-discharge procedures

Strengthen post-discharge procedures, including: starting discharge discussions from the day of admission, including discussions with family members and caregivers; education of patients; and improving care transitions.4

Financial incentives

Offer financial incentives for reduced readmissions and penalties for increased readmissions.5

Patient-centered care

Increase patient-centered care. For example, case management for patients with certain risk factors or multiple conditions that includes regular checkups, medication review, community linkages, and education on identification of early symptoms.3

Data Disparities & Trends

Readmission rates by age were highest for Californians age 65 and older (15.0%).1

Readmission rates by race and ethnicity were highest for black Californians (18.2%).1

As with other quality measures, there is broad variability in readmission rates at the regional, county, and facility levels.

The readmission rate was higher for patients with Medi-Cal coverage (15.7%) than private insurance (10.4%). However, the 2015 rate for patients with Medi-Cal is significantly lower than it was in 2013 (17.5%), due to the increase in non-elderly adults covered by Medi-Cal under the Affordable Care Act.1

For some patient groups, readmissions have fallen considerably from 2011 to 2015. For instance, patients age 65+ have experienced a 6% reduction in readmissions since 2011, and Medi-Cal patients have seen a 13% reduction in read-missions – most of that occurring in 2014. In fact, the only demographic group that experienced an increase in readmissions (nearly 4%) was patients aged 18-44 years.1

Rate of Unplanned Hospital Readmissions Within 30 Days of Discharge, Over Time

Rate of Unplanned Hospital Readmissions Within 30 Days of Discharge, by Demographic Category

Rate of Unplanned Hospital Readmissions Within 30 Days of Discharge, by County

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Indicator: 30-Day All Cause Hospital Readmission Rate, California

Description: This provides the statewide number and (unadjusted) rate for all-cause, unplanned, 30-day inpatient readmissions in California hospitals. Methodology for this indicator was modified from the CMS 30-day all-cause readmission measure and includes all adult (18 years and older) patients. Data are categorized by age, sex, race/ethnicity, and expected payer.

Data Limitations: The statewide 30-day readmission rate is not risk-adjusted, and the methodology is not the same as for the CMS 30-day all-cause readmission measure. Please check the attached file for more details.
Data for 2015 are reported for nine months only due to a coding change from ICD-9 to ICD-10. Comparisons across years should be made with caution since 2011-2014 results are based on 12 months of data, while 2015 rates are based on 9 months of data. Comparisons between ICD-9 and ICD-10 should not be made.

Indicator Source: Office of Statewide Health Planning and Development, Healthcare Information Division, Healthcare Outcomes Center

Data Collection Methodology:
http://chhs.data.ca.gov/api/views/6egg-47qn/files/xwiJzg9hMElml_-yFtKpOoIxmJcpwjfW50QVw5MPkU0?download=true&filename=Methodology%20-%2030-Day%20All%20Cause%20Hospital%20Readmission%20Rate%20.pdf

1. 2015 LGHC Data Report – Readmission Data
2. Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: Paying for coordinated quality care. JAMA. 2011;306(16):1794-1795.
3. Benbassat J, Taragin MI. The effect of clinical interventions on hospital readmissions: A meta-review of published meta-analyses. Israel J. of Health Policy Res. 2013;2(1):1-15.
4. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease re-hospitalization: A randomized trial. Annu Intern Med. 2009;150(3):178.
5. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HRRP/Hospital-Readmission-Reduction-Program.html

Stories & Solutions

The California HealthCare Foundation highlights nine examples of patient-centered programs to reduce readmissions

CHCF highlighted two exemplary California Programs including: 1) Sharp Rees-Stealy Medical Group reduced hospital readmissions and generates a positive return on investment by using nurse case managers to improve the transition of care process for high-risk patients; and 2) Blue Shield of California developed a patient-centered management program that used [...]

Centers for Medicare & Medicaid Services (CMS) has implemented incentives to reduce hospital readmissions

Under the Affordable Care Act, CMS has implemented the Hospital Readmission Reduction Program (HRRP) which aims to reduce preventable hospital admissions by penalizing hospitals with relatively higher rates of Medicare insured readmissions. Since implementation of the HRRP, reducing hospital readmissions has gained traction among providers and policymakers. Evaluating the HRRP [...]

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