Evaluating Hospital Readmissions for Persons With Serious and Complex Illness: A Competing Risks Approach

Peter May, Melissa M. Garrido, Egidio Del Fabbro, Danielle Noreika, Charles Normand, Nevena Skoro, J. Brian Cassel

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Hospital readmission rate is a ubiquitous measure of efficiency and quality. Individuals with life-limiting illnesses account heavily for admissions but evaluation is complicated by high-mortality rates. We report a retrospective cohort study examining the association between palliative care (PC) and readmissions while controlling for postdischarge mortality with a competing risks approach. Eligible participants were adult inpatients admitted to an academic, safety-net medical center (2009-2015) with at least one diagnosis of cancer, heart failure, chronic obstructive pulmonary disease, liver failure, kidney failure, AIDS/HIV, and selected neurodegenerative conditions. PC was associated with reduced 30-, 60-, and 90-day readmissions (subhazard ratios = 0.57, 0.53, and 0.52, respectively [all p <.001]). Hospital PC is associated with a reduction in readmissions, and this is not explained by higher mortality among PC patients. Performance measures only counting those alive at a given end point may underestimate systematically the effects of treatments with a high-mortality rate.

Original languageEnglish (US)
Pages (from-to)574-583
Number of pages10
JournalMedical Care Research and Review
Issue number6
StatePublished - Dec 1 2020
Externally publishedYes


  • hospital readmissions
  • mortality
  • palliative care
  • retrospective studies

ASJC Scopus subject areas

  • Health Policy


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