Use of Hospital-Based Acute Care Among Patients Recently Discharged From the Hospital

Hospital readmission rates are often used as a marker of quality of care provided to patients who are effectively transitioned to an outpatient setting, with low rates desirable. However, emergency department (ED) visits that do not result in readmissions may indicate poorly executed transitions in care.

These researchers wanted to determine the degree to which ED visits and hospital readmissions contribute to the overall use of acute care services. They examined data on 4 million unique patients discharged from acute care hospitals in 200–09 in three geographically diverse states: California, Florida, and Nebraska. The mean age of patients was 53 years. Most had some insurance (75%); either private insurance (32%), Medicare (30%), or Medicaid (15%).

Key Findings:

  • For all the hospitalizations, 18 percent resulted in at least one acute care encounter in the 30 days after hospital discharge.
  • For every 1,000 discharges, there were 148 readmissions and 98 treat-and-release ED visits.
  • Patients with Medicare coverage returned to the ED at similar rates as patients without Medicare. Their readmission rates, however, were considerably different: 197 per 1,000 discharges for Medicare versus 111 for non-Medicare.

“Even if readmission rates decrease,” the authors write, “high or increasing rates of ED use during the period after hospital discharge may reflect shortcomings in access to and delivery of care during the transition from hospital to home.”