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

Background: The role of the emergency department (ED) provider and ED facility in readmissions of recently discharged patients who visit the ED has not been studied. Objective: To determine the variation in readmission rates by ED facility and ED providers caring for patients after discharge. Design: Retrospective cohort study using multilevel, multivariable models of 100% Texas Medicare claims data from the years 2007 to 2011. Setting: Texas acute-care hospitals and ED facilities. Patients: Medicare beneficiaries who visited an ED within 30 days of discharge from a hospital. Intervention: None. 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. Results: The 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. Conclusions: The 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.