HPSH Study: High-Quality Surgical Care Linked to Low Hospital Readmission Rate

Patients at hospitals that offer better surgical care are less likely to be readmitted within a month of discharge, according to a recent study from the Harvard School of Public Health.

The study, published last week in the New England Journal of Medicine, provided numerical evidence that surgery, unlike general hospital care, can be assessed through hospital readmission rates.

The usefulness of hospital readmissions rates as a metric for quality of clinical care has long been met with debate in the medical policy field. The controversy stems from the difficulty of determining whether patients’ readmissions are a result of a chronic sickness or the insufficient care in the hospital.

“When it comes to medical conditions like heart failure or pneumonia, what you see is a lot of those readmissions are really because those patients are very sick or they might be poor and not have access to primary care,” said Ashish K. Jha, one of the study’s authors.

Jha and his colleagues found that for the case of surgery, the main contingent that is driving surgical admission is the quality of surgical care. Because elective surgery patients are generally stable before surgery, readmission can more accurately be attributed to surgical intervention, according to Jha.

In addition to adjusted mortality rates, the researchers used surgical volume—the number of surgeries a hospital administers in a given period of time—as an indicator of quality of surgical care. Past studies have correlated high hospital surgical volume with high quality of surgical care.

Further complicating the issue, the validity of the readmissions metric is politically charged, as the Medicare system financially penalizes hospitals with rates of readmission higher than a set standard.

“If we can reduce readmissions, we can cut costs while improving quality, which is good news for everybody,” said Thomas C. Tsai ’05, a postdoctoral fellow at the School of Public Health and the lead author of the study. “For patients, for surgeons, for hospitals, for Medicare, and ultimately for taxpayers as well.”

The study also suggests the benefits of hospitals putting extra emphasis on improving care before, during, and after surgery care to decrease surgical readmissions costs.

“It forces better integration of care, care coordination, and transition of care from the hospital to wherever the patient goes after the hospital,” Tsai said.

This article has been revised to reflect the following correction:

CORRECTION: Sept. 27, 2013

An earlier version of this article misstated the gender of Harvard Medical School and Harvard School of Public Health professor Ashish K. Jha, who is in fact a man.