Researchers also suggest hospital quality assessment should not focus only on readmissions
An analysis of patients admitted to Kaiser Permanente Northern California hospitals over 7 years finds a steadily declining rate of hospitalizations and readmissions, in line with federal health policy that encourages hospitals to reduce the number of patients who end up back in the hospital.
The decline occurred even as admitted patients’ illnesses grew in severity over the study period. That’s because Kaiser Permanente is able to assist patients with less severe ailments using a telephone help line, video doctor visits, and careful monitoring of those with chronic illnesses, the study’s authors said.
By documenting reduced mortality and hospital readmissions, the researchers said, their study showed that reducing hospitalization rates benefits patients and does not worsen their health.
This analysis, published Dec. 4 in JAMA Network Open, examined several outcomes for patients admitted to Kaiser Permanente’s 21 Northern California hospitals between 2010 and 2017.
The findings suggest an integrated health system such as Kaiser Permanente can use its close connections among physicians, nurses and specialty caregivers, and hospital and health plan administrators to make significant improvements in patient care, said lead author Gabriel Escobar, MD, research scientist with the Kaiser 
Permanente Division of Research.
“Kaiser Permanente is actually reducing the hospitalization rate,” Dr. Escobar said. “The best way to prevent a readmission is to not admit the patient in the first place.”
The study included outcomes for 1.4 million hospitalizations: inpatient mortality, 30-day mortality, 30-day post-discharge mortality, non-elective rehospitalization, and disposition, whether to home or to a skilled nursing facility. The authors found that over 7 years hospitalizations fell from 5.5 per 1,000 members to 4.8 per 1,000 members, with a greater decrease (17.2 to 14.9 per 1,000) among those over 65. This was accompanied by decreases in mortality (specifically, risk-adjusted inpatient, 30-day, and 30-day post-discharge mortality).
The authors also found that the proportion of patient outcomes subject to public reporting fell substantially over the study period, mostly related to exclusion of patients admitted under observation status.
The research was funded by The Permanente Medical Group and Kaiser Foundation Hospitals.
Coauthors were Patricia Kipnis, PhD, of The Permanente Medical Group Consulting Services, and Vincent Liu, MD, MS, Colleen Plimier, MPH, and John D. Greene, MA, all of the Division of Research.
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