Cost of hospital readmissions 'disproportionally high': study

A recent study from the University of Queensland highlights the potentially preventable cost of unexpected hospital readmissions.

Researchers, led by health economist and PhD candidate Trang Dang, analysed data from more than 165,000 hospitalisations for heart failure in all public and most private hospitals in Australia from 2013 to 2017.

Almost a quarter of these patients had an unplanned readmission in the first month after discharge, Dang said.

The study found that the direct cost of the initial heart failure hospitalisation to be $1.88 billion over this period.

“However, an additional $604 million was spent on treating subsequent unplanned readmissions, an amount equal to a third of the cost of the initial admission,” Dang said.

“Most readmissions costs were for care of potentially preventable hospital-acquired complications, such as pneumonia, sepsis and kidney failure (40.1%) or for recurrent heart failure (35.6%).

“The readmission cost was disproportionally high because patients often have more than one readmission within the month, and because the cost of treating complications was often higher than the cost of the initial heart failure hospitalisation,” Dang said.

Co-author and cardiologist Associate Professor Isuru Ranasinghe from the Prince Charles Hospital said the findings highlighted how common readmissions are and the staggering cost to the health system.

“It was important that we understood the impact of these readmissions, as cost considerations are a key driver of healthcare decision-making,” he said.

“There is considerable pressure on hospital beds and resources in Australia, with bed block and ambulance ramping frequently a concern for patients and hospitals alike.”

Ranasinghe said the study illustrated how incredibly costly it is to manage these readmissions, and how it is likely diverting resources from stretched acute care services.

“Not all readmissions are preventable, and some will occur even with the best possible care,” he said.

“Nevertheless, we know from existing clinical trials that at least a quarter or more can be reduced with effective intervention.

“However, existing data also show that the quality of heart failure care in Australia is suboptimal.

“Moreover, readmission rates are known to vary twofold among Australian hospitals, meaning these interventions are probably not consistently applied in practice.”

Ranasinghe said improving the quality of heart failure care and implementing strategies proven to reduce readmissions is urgently required.

“Best-practice clinical guidelines also recommend reporting hospital 30-day readmission rates as a measure of heart failure care quality, and while readmission rates are publicly reported in several countries, they are not reported in Australia.

“It is incredibly difficult to improve something that is not measured, and thus not visible to clinicians or health services. Readmission rates for heart failure should be routinely reported to improve care,” Ranasinghe said.

The study was published in the Medical Journal of Australia.

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