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The 30-day Unplanned Readmission Rate and Hospital Volume: A National Population-Based Study in South Korea

Authors
 Hoo-Yeon Lee  ;  Jae Yong Shin  ;  Sang Ah Lee  ;  Yeong Jun Ju  ;  Eun-Cheol Park 
Citation
 INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol.31(10) : 768-773, 2019-12 
Journal Title
 INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE 
ISSN
 1353-4505 
Issue Date
2019-12
Keywords
hospital volume ; hospital-wide standardized readmission rate ; unplanned readmission
Abstract
Objective: To examine the association between hospital volume and the unplanned 30-day readmission rate as a quality measure. Design: A retrospective cross-sectional study. Setting: The Korea healthcare system is operated by a single payer under the National Health Insurance Service. Participants: Using national health claims data of the Health Insurance Review and Assessment in South Korea, we examined 1 296 275 adult discharges (≥18 years old) from 90 hospitals (≥500 beds) in the 2013 calendar year. Main outcome measures: We analysed the 30-day, unplanned, observed-to-expected standardized readmission rate for hospitals and for five specialty cohorts: medicine, surgery/gynaecology, cardiovascular, cardiorespiratory, and neurology. We assessed the association between hospital volume by tertiles and the 30-day standardized readmission rates with and without adjustment for hospital characteristics. Results: The rate for the lowest-volume hospitals was 6.10 compared with 6.20 for the highest-volume hospitals. We observed the standardized readmission rates did not differ significantly between the lowest- and highest-volume groups, except for the neurology cohort, which remained significant after adjusting for hospital characteristics. Conclusions: The standardized readmission rates were not associated with hospital volume, except for the neurology cohort, in which the standardized readmission rate was significantly higher in the highest-volume hospitals than in lowest- and intermediate-volume hospitals, which was not consistent with the typical association of greater hospital volume with better outcomes. This association was independent of hospital characteristics. Therefore, the rate of readmissions should be used with caution when gauging the quality of hospital care according to hospital volume.
Full Text
https://academic.oup.com/intqhc/article/31/10/768/5489515
DOI
10.1093/intqhc/mzz044
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175831
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