A study by Eastern researchers of hospital readmission rates for patients with congestive heart failure shows that longer initial hospital stays reduce the risk of readmission, a finding that could help the healthcare industry with cost containment and quality of care.

Fatma Pakdil, professor of management, and Steve Muchiri, associate professor of economics, were two of the authors of a paper published online Dec. 22 in the International Journal of Healthcare Management: “Examining readmission rates of congestive heart failure patients in the United States between 2010 and 2017 – does length of stay matter?”

Other authors are Hannah Beazoglou ‘21, a former business administration student at Eastern who is now an associate in CVS Health’s General Management Development Program, and Nasibeh Azadeh-Fard, an assistant professor at Rochester Institute of Technology.

The researchers took a more expansive approach than earlier studies, analyzing eight years of national readmission data from the Healthcare Cost and Utilization Project, a comprehensive source of hospital data maintained by an agency of the Department of Health and Human Services. They also accounted for missing variables on length of stay, or what is known as endogeneity bias.

They found that when congestive heart failure patients stay longer at the hospital, they are less likely to be readmitted within 30 days. Previous studies had shown mixed results on whether the length of the initial stay affects readmission.

About 20% of Medicare patients are readmitted within 30 days of their hospital discharge at a yearly cost of $17 billion, other studies have shown.

“Remarkably, the readmission cost is higher than the cost of keeping patients longer during their initial admission,” they wrote.

Congestive heart failure (CHF) is one of the leading causes of hospitalization for those over 65, and CHF patients have a high hospital readmission rate, the authors said. Their study showed a 24% readmission rate among nearly 2.6 million CHF patients, with readmission defined as going back to the hospital for the same diagnosis within 30 days. The average age of patients sampled was 72 years, meaning that most were insured by Medicare. Medicare and Medicaid patients have relatively higher readmission rates than privately insured patients and a low average of five days for initial hospitalization, the researchers found.

Length of stay and preventable readmission rates are two common performance indicators of the quality and cost of healthcare. They influence healthcare policy and, if too high, can result in penalties to hospitals receiving Medicare reimbursements. Higher costs associated with readmission may also be transferred to patients if they do not have adequate insurance coverage, the authors noted.

Hospitals are facing a constant push for shorter initial length of stays as well as for keeping readmission rates low, they said. Yet a shorter initial length of stay has a negative and significant impact on the probability of 30-day hospital readmission for CHF patients. An extra day in initial hospitalization reduces the probability of 30-day readmission by about 6 percentage points for routine discharges, they found.

In future work, the researchers said they will explore the relationship between length of stay and readmission for patients with other diseases, such as chronic obstructive pulmonary disease (COPD) and coronary artery bypass graft.