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About 2 in 3 Medicare beneficiaries who were discharged into the community following hospitalization in 2003 or 2004 were rehospitalized or died within a year, according to a recent New England Journal of Medicine article. Only 10% of the rehospitalizations were estimated to have been planned. This highlights the extent to which patients who enter the healthcare system feed back into it. One reason patients might be expected to fall ill again is that they might be chronically ill, or because issues related to their initial hospitalization resurface. Another reason for these bad outcomes following hospitalization is that patients might pick up a new illness as a result of the hospital care they receive -- in particular, they might acquire a healthcare-associated infection.

 
The New England Journal paper provides some information on the reasons these Medicare patients were rehospitalized. Among medical patients, the second most frequent cause for rehospitalization was pneumonia (7.3% of rehospitalizations), with urinary tract infection and septicemia (a serious bloodstream infection) in the top 10 reasons for rehospitalization. Among surgical patients, pneumonia and septicemia were the 2nd and 4th most common reasons for rehospitalization, accounting for 4.5% and 2.9% of rehospitalizations, respectively, and 2 other types of infections were among the top 10 reasons. We don't know how many of these cases of infection were hospital-acquired, and the documentation of these reasons is far from comprehensive, but these numbers certainly suggest that healthcare-associated infections may be important reasons for rehospitalization.
 
If 12 million Medicare patients are hospitalized and subsequently discharged into the community each year as the article reports, and 2 in 3 of these patients are rehospitalized or die within a year from discharge, then even if we assume that only 4% of rehospitalizations or deaths were due to healthcare-associated infections, we would estimate that 300,000 of these Medicare patients end up being rehospitalized or dying due to healthcare-associated infections.
 
These numbers suggest a large impact of healthcare-associated infections that appear after hospital discharge. These healthcare-associated infections generally receive less attention than those infections that are discovered during the initial hospitalization because they are far harder to track. Healthcare-associated infections are a costly burden to patients and healthcare institutions. They also force the healthcare system to use more antibiotics to treat infections that may be preventable, which may perpetuate the problem of antibiotic resistance.