Nationally, readmissions have declined for acute myocardial infarction (AMI) and heart failure (HF) and risen slightly for pneumonia, but less is known about returns to the hospital for observation stays and emergency department (ED) visits.OBJECTIVE
To describe trends in rates of 30-day, all-cause, unplanned returns to the hospital, including returns for observation stays and ED visits.DESIGN
By using Healthcare Cost and Utilization Project data, we compared 210,007 index hospitalizations in 2009 and 2010 with 212,833 matched hospitalizations in 2013 and 2014.SETTING
Two hundred and one hospitals in Georgia, Nebraska, South Carolina, and Tennessee.PATIENTS
Adults with private insurance, Medicaid, or no insurance and seniors with Medicare who were hospitalized for AMI, HF, and pneumonia.MEASUREMENTS
Thirty-day hospital return rates for inpatient, observation, and ED visits.RESULTS
Return rates remained stable among adults with private insurance (15.1% vs 15.3%; P = .45) and declined modestly among seniors with Medicare (25.3% vs 25.0%; P = .04). Increases in observation and ED visits coincided with declines in readmissions (8.9% vs 8.2% for private insurance and 18.3% vs 16.9% for Medicare, both P ≤ .001). Return rates rose among patients with Medicaid (31.0% vs 32.1%; P = .04) and the uninsured (18.8% vs 20.1%; P = .004). Readmissions remained stable (18.7% for Medicaid and 9.5% for uninsured patients, both P > .75) while observation and ED visits increased.CONCLUSIONS
Total returns to the hospital are stable or rising, likely because of growth in observation and ED visits. Hospitalists’ efforts to improve the quality and value of hospital care should consider observation and ED care.