Background: Although many hospital readmission reduction initiatives
have been introduced globally, health care systems ultimately aim to
improve patients’ health and well-being. We examined whether the
hospitals that report greater success in reducing readmissions also see
greater improvements in patient-reported outcomes.
Research Design: We examined hospital groups (Trusts) that
provided hip replacement or knee replacement surgery in England
between April 2010 and February 2013. For each Trust, we calculated
risk-adjusted 30-day readmission rates from administrative datasets. We
also obtained changes in patient-reported health between presurgical
assessment and 6-month follow-up, using general health EuroQuol five
dimensions questionaire (EQ-5D) and EuroQuol visual analogue scales
(EQ-VAS) and procedure-specific (Oxford Hip and Knee Scores)
measures. Panel models were used to assess whether changes over time
in risk-adjusted readmission rates were associated with changes over
time in risk-adjusted health gains.
Results: Each percentage point reduction in the risk-adjusted readmission
rate for hip replacement was associated with an additional
health gain of 0.004 for EQ-5D [95% confidence interval
(CI), 0.002–0.006], 0.39 for EQ-VAS (95% CI, 0.26–0.52), and
0.32 for Oxford Hip Score (95% CI, 0.15–0.27). Corresponding
figures for knee replacement were 0.003 for EQ-5D (95% CI,
0.001–0.004), 0.21 for EQ-VAS (95% CI, 0.12–0.30), and 0.14 in
the Oxford Knee Score (95% CI, 0.09–0.20).
Conclusions: Reductions in readmission rates were associated with
modest improvements in patients’ sense of their health and wellbeing
at the hospital group level. In particular, fears that efforts to
reduce readmission rates have had unintended consequences for
patients appear to be unfounded.