Discharge Instructions, Readmission, and Mortality

The purpose of this analysis is to examine how patient-physician communication impacts readmission rates, mortality rates, and payment in various types of hospitals.

Hospitals have a strong reason to reduce readmissions – it cuts costs and betters both patient satisfaction and health results (Centers for Medicare & Medicaid Services(CMS), 2021). Nearly 17% of elderly patients get readmitted within a month of leaving the hospital, and a lot of these instances could be prevented (Bailey et al, 2019). As of 2012, hospitals started facing penalties from the U.S. government for readmissions that could've been avoided (CMS, n.d.). A bigger focus is now on giving patients clear instructions upon discharge and ensuring proper follow-up care to improve health outcomes (Bennett & Probst, 2016). 

Additionally, patient engagement has become a significant focus in the US healthcare system, driven by the understanding that higher levels of patient engagement are connected to better satisfaction and improved clinical outcomes (Hibbard & Greene, 2013, Henning-Smith et al., 2020). Consequently, the Centers for Medicare & Medicaid Services (CMS) have integrated patient and family engagement into the Quality Payment Program. A central goal of patient engagement is enhancing communication between healthcare providers/organizations and patients. Patients who comprehend the health-related information about their care tend to experience improved outcomes (Kelley et al., 2014). A key indicator of clinical communication is the frequency with which physicians effectively communicate with patients during their hospital stay.

This analysis examines how patient-physician communication affects readmission rates, mortality rates, and payment in different hospitals. It can help hospitals improve their care quality and patient satisfaction. 

This data is also available as an Excel spreadsheet.

Discharge Instructions, Readmission, and Mortality Demographics 2023 (Excel) (8.6 MB)

This data represents the most current publicly available information sources that are commonly used to study health care trends. The data is derived from the data sources listed below and combined to support the analysis.

A blank entry indicates unreported data. A value of zero is a defined value and does not represent unreported data.

State: The abbreviated name of the state where the hospital is located.

County: The name of the county where the hospital is located. County names are listed as provided on the US Census Bureau's list of 2020 FIPS Codes for Counties and County Equivalent Entities.

County Population Size:  The total number of individuals residing in the county. The data is derived from the Census Population Estimates from 2021.

Population Type: The population type is determined based on the population size of a specific county. The population types include metro, nonmetro cities, and nonmetro towns. These types are adapted from the rural-urban commuting area codes (RUCA) and core-based statistical areas (CBSA) definitions of rural and urban. The population types for counties are defined as follows:

  • Metro - A population of 50,000 or more
  • Nonmetro cities - A population between 2,500 and less than 50,000
  • Nonmetro towns - A population of less than 2,500

Hospital: The name of the hospital.

Address: The address for the hospital.

City: The city where the hospital is located.

ZIP Code: The zip code for the hospital.

Hospital Type: The type of hospital, which includes acute care hospitals, acute care - Department of Defense hospitals, critical access hospitals, and children's hospitals.

Hospital Ownership: The ownership type for the hospital, which includes: Voluntary non-profit - Private, Voluntary non-profit - Other, Voluntary non-profit - Church, Tribal, Proprietary, Physician, Government - State, Government - Local, Government - Hospital District of Authority, Government - Federal, Department of Defense.

Percent of Doctors That Always Communicate: The percentage of hospital inpatients reporting that doctors always communicate well from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey about patient experience and satisfaction. The reporting period for this measure is October 1, 2021, through September 30, 2022.

HF Payment: Average Medicare spending per beneficiary for heart failure (HF) patients spanning three days prior to an inpatient admission to 30 days after discharge.

Payment Denominator: Number of HF patients seen by the hospital during the reporting period. The reporting period for this measure is July 1, 2019, through June 30, 2022.

Health Outcome Measure: The name of the major complications and death measures. The measures include mortality and readmission rates for acute myocardial infarction, coronary artery bypass grafting, chronic obstructive pulmonary disease, heart attack, heart failure, stroke, pneumonia, and hip/knee replacement. Measures are also included for hospital-wide readmissions and death rates among surgical inpatients with serious treatable complications. 

Health Outcome Rate: The rate for the specific health outcome measure. A lower measure is desired as this indicates a lower proportion of HF mortality and HF readmissions. The reporting period for these measures is July 1, 2019, through June 30, 2022.

Tutorial Video

In this tutorial video, we look at the Discharge Instructions, Readmission, and Mortality dashboard. The video guides you through how to use Tableau data analysis to compare the rates of patients who reported that they were given information about what to do during their recovery at home, given the rates of readmissions and mortality for acute myocardial infarction, coronary artery bypass grafting (CABG), chronic obstructive pulmonary disease, stroke, heart failure, pneumonia, and hip/knee replacement at multiple levels, including state, county, and hospital type.


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