@article {232266,
	title = {Care fragmentation in the postdischarge period: surgical readmissions, distance of travel, and postoperative mortality.},
	journal = {JAMA Surg},
	volume = {150},
	number = {1},
	year = {2015},
	month = {2015 Jan 1},
	pages = {59-64},
	abstract = {IMPORTANCE: Despite policies aimed at incentivizing clinical integration, few data exist on whether fragmentation of care is associated with worse outcomes for elderly patients undergoing major surgery.

OBJECTIVE: To determine whether postdischarge surgical care fragmentation is associated with worse outcomes and whether distances between hospitals explain differences in patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS: We used the 100\% Medicare inpatient file for claims from January 1, 2009, through November 30, 2011. Data on hospital structural features, including zip code of location, were obtained from the 2011 American Hospital Association Annual Survey. We identified patients who underwent coronary artery bypass grafting, pulmonary lobectomy, endovascular abdominal aortic aneurysm repair, open abdominal aortic aneurysm repair, colectomy, and hip replacement.

MAIN OUTCOMES AND MEASURES: Thirty-day surgical mortality.

RESULTS: A total of 93 062 patients who underwent the surgical procedures of interest were subsequently readmitted within 30 days of discharge; 23 278 of these patients (25.0\%) were readmitted to a hospital other than the one where their procedure was performed. Patients who were readmitted to a different hospital generally lived farther from the index hospital than those who were readmitted to the index hospital (20.7 vs 7.4 miles, P ,
	issn = {2168-6262},
	doi = {10.1001/jamasurg.2014.2071},
	author = {Tsai, Thomas C. and Orav, E. John and Jha, Ashish K}
}
