Dive Brief:
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Each year, around 10,000 relatively healthy Medicare patients die within seven days of a discharge from the emergency department (ED), according to research published by BMJ.
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Most of the deaths occurred in hospitals that infrequently made inpatient admissions from the ED and patients affected most frequently dies from heart disease or chronic obstructive pulmonary disease (COPD).
- Results to this study and others suggest socioeconomic status plays a role in outcomes.
Dive Insight:
In the age of value-based care, discussion often centers around ways to keep patients out of the hospital.
Patients admitted to EDs at certain hospitals were much more likely to die than those at others,the researchers found. Deaths following an ED discharge were much less likely to occur at university-affiliated hospitals than at rural hospitals, where dedicated internists are less common. Socioeconomic factors also played a role and the researchers surmised that low-income individuals were affected the most.
This is not the first study to determine wide variations in outcomes from one hospital to the next. One recent study found patients admitted to hospitals scoring poorly against quality measures were 13 times more likely to die than patients admitted to high-performing hospitals.
Socioeconomic status is frequently cited by researchers investigating quality gaps. Some suggest this status contributes to poor outcomes at low-performing hospitals and these poor outcomes are outside hospitals’ control. For instance, authors of the BMJ study noted patients who are likely to die might be eligible for taxi vouchers through public health plans, but live in areas where taxi service is not available.
The quality gap has led some to suggest changing policy to account for socioeconomic status. Authors of a recent study published in Health affairs suggested a 7-day readmission rate would be a more accurate quality measure than a 30-day readmission rate partly for this reason. Hospitals have also been pushing for changes to readmission penalties for this reason, as Modern Healthcare reported.
If nothing else, results to the BMJ study show how difficult it can be for providers to get admission right every time. “There’s no doubt there’s a lot of unnecessary hospital admissions, but this study suggests there’s also avoidable harm from sending people home that shouldn’t go home,” Dr. Ziad Obermeyer, a Harvard Medical School professor and lead author of the study, told STAT.