Variation in readmission rates by emergency departments and emergency department providers caring for patients after discharge

BACKGROUNDThe role of the emergency department (ED) provider and ED facility in readmissions of recently discharged patients who visit the ED has not been studied. OBJECTIVETo determine the variation in readmission rates by ED facility and ED providers caring for patients after discharge. DESIGNRetrospective cohort study using multilevel, multivariable models of 100% Texas Medicare claims data from the years 2007 to 2011. SETTINGTexas acute-care hospitals and ED facilities. PATIENTS: Medicare beneficiaries who visited an ED within 30 days of discharge from a hospital. INTERVENTIONNone. MEASUREMENT: Readmission after an ED visit within 30 days of discharge from an initial hospitalization defined as a hospitalization starting the day of or the day following the ED visit. RESULTSThe mean readmission rate following an ED visit was 52.67%. In 2-level models, 14.2% of ED providers readmitted significantly more patients (mean readmission rate of 67.2%) than the mean; 14.7% of ED providers readmitted significantly fewer patients (mean readmission rate of 36.8%) than the mean. After accounting for the ED facility in 3-level models, the variance for the ED providers decreased 65% from 0.2532 to 0.0893. CONCLUSIONSThe risk of readmission varies by ED provider caring for patients after discharge. A large part of this variation is explained by the ED facility in which the ED providers practice. Thus, ED provider practices patterns and ED facility systems of care may be a target for interventions to reduce readmissions. Journal of Hospital Medicine 2015;10:705-710. (c) 2015 Society of Hospital Medicine