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Too many Medicare enrollees are being readmitted to the hospital to be treated for the same infection they had while they were inpatients, a new study shows.
Researchers at the University of Michigan looked at more than 318,000 hospital discharge records for Medicare patients 65 and older and found that 2.5 percent returned to the hospital within a month to treat the same infection they left with — also called a linked infection.
The study's lead author, Geoffrey Hoffman, said that number may seem small, but “it should be closer to zero” when looking at people having to be readmitted for something that's curable, like an infection, compared to a condition that's chronic, such as heart failure. Clostridioides difficile — a potentially deadly germ that causes diarrhea, fever and stomach pain or nausea — was the most common infection for which patients were readmitted; urinary tract infections were the second. Both can be treated with antibiotics, “and you shouldn't have to come back [to the hospital] for those,” said Hoffman, an assistant professor at the University of Michigan School of Nursing.
The readmissions number “should be of concern for hospitals and their infection prevention programs,” Hoffman added. “They should make sure they're not just focused on the hospital stay, but also what happens to the patient afterwards.”
Currently, Medicare provides financial incentives to hospitals to minimize the number of infections patients pick up during their stay. If a Medicare beneficiary gets certain types of infections while they are in the hospital, the government won't pay the hospital to treat it — and the patient doesn't have to pay, either. Extending such programs to monitor whether infections persist once a patient is released may help to reduce readmissions, Hoffman said.
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Where you recover after a hospital visit could also affect your chances for readmission, the researchers found. Patients who go from the hospital to home — with or without home care — were 38 percent more likely to return to the hospital with a linked infection than those discharged to skilled nursing facilities.
"Skilled nursing facilities are typically considered to be, if you will, dangerous places for picking up an infection, and for spreading or transmitting infections to other patients … but we found the opposite,” Hoffman said.
He explained that while these facilities do struggle with high infection rates, they are likely better equipped to treat them, “as opposed to someone on their own at home or at a home health care agency where they may not have as structured of an infection control program.”
The findings indicate that hospitals should consider sending patients with infections to skilled nursing facilities, and not necessarily home, Hoffman said. “And then, if they are going to send them home, maybe think about providing some more education or other needed resources.”
Hospital readmissions are often viewed as a quality indicator. If you leave the hospital and are “unaware of how to optimally self-manage your condition,” you're more likely to end up back in the hospital, Hoffman said. “And that's a signal of a gap in quality.”
But for older adults, hospital readmission can also be a health hazard. Older patients are more likely to stay in bed and move around less at hospitals, which, research shows, can lead to cognitive and physical declines once they are released. They can also pick up infections.
Hoffman said the last thing he wants to do is put more burden on patients and caregivers, but he recommends they “learn about the risks that are out there.” He said don't be afraid to ask questions if you don't understand discharge instructions; and if you are prescribed antibiotics, make sure to follow the doctor's instructions on how to take them. Also, talk to your hospital team about where would be the best place for you to recover after a hospital stay.
"Just know that you really don't want an infection to linger, and you don't want to go back to the hospital for it. You want to treat that as soon as possible,” Hoffman said.