Juliet Rumball-Smith 2007
The quality of inpatient care may be monitored and evaluated using the rate of readmission. This study uses nationwide data to investigate the annual readmission rate between 2000 and 2004 of patients aged 65 years and over, following elective admission for one of five specified surgical procedures. Policy and health system interventions during the study period are examined to assess their possible influences on the quality of inpatient care.
Data from the National Minimum Dataset was used to calculate an annual rate for the elderly who were readmitted or deceased within 30-days of discharge following an elective transurethral prostatectomy, laparoscopic cholecystectomy, knee arthroplasty, hip arthroplasty, or inguinal hernia repair.
Between 1 July 2000 and 30 June 2004, 21398 subjects were included in the study, and of these 1763 (8.2%) were readmitted or deceased within 30-days of discharge (termed rate of 'RD'). The annual rates were: 7.9% (2000/01), 7.5% (2001/02), 8.2% (2002/03), and 8.5% (2003/04). There was a difference in the rate of RD between 2001/02 and 2003/04 with a risk ratio calculated of 1.13, although this difference did not quite meet statistical significance (95% CI 1.00, 1.27). Demographic analysis revealed that patients aged 80 years or over were at increased risk of RD (RR 1.38, 95% CI 1.26, 1.51), as were male subjects (RR 1.26, 95% CI 1.12, 1.41). Age standardisation demonstrated that the rate of RD also varied by ethnicity: the relative risk for Maori was estimated at 1.6 (95% CI 1.2, 2.3), and at 1.8 for Pacific people (95% CI 0.8, 4.1) when compared to that of the Non-Maori Non-Pacific study population.
In our study population the rate of RD increased between 2000 and 2004, and its relative risk varied with gender, age and ethnicity. A review of relevant health system and policy initiatives revealed that some national health system and policy interventions may have had a negative impact on quality of care, whereas the effect of other interventions may be positive but minimal, or delayed. It is possible that these initiatives may have affected the trend in readmission rate during this time. There is a need for research to quantify the relative impacts of different policies on the quality of care. Future investigation is also indicated to ascertain why the readmission rate is increasing, and evaluate the quality of hospital care in New Zealand with respect to ethnicity, age and gender.