Recasting readmissions by placing the hospital role in community context

HOSPITAL READMISSIONS ARE UNDER SCRUTINY BY policy makers but are hardly a new problem. For more than 30 years, researchers have studied factors associated with readmission and tested care models to address these admissions, yet rates of readmissions have not declined appreciably during this time. The renewed focus on readmissions has been stimulated by several converging forces rather than by a strong evidence base for how improvements can be reliably achieved. US federal financial penalties for high rates of readmissions focus on hospitals as the locus of accountability for the problem, but such penalties are a weak incentive since the investment required to improve may exceed the potential loss of inpatient revenue. In this Viewpoint, we suggest that it may be more advantageous to view readmissions within a broader systems and community context that effectively engages all stakeholders to cooperatively improve outcomes.