Agentic Artificial Intelligence for Hospital Readmission Review: A Single-Center Blinded Evaluation and Exploratory Qualitative Analysis
Background: Manual review of 30-day hospital readmissions can identify actionable quality and safety problems, but it is labor-intensive. We developed and evaluated an agentic AI workflow for evidence-grounded readmission review. Materials and methods: We studied adult patients with unplanned 30-day readmission after discharge from a medicine hospitalist service at a single academic health system. An AI agent using a large language model queried a database containing notes, encounters, procedures, laboratory results, and other clinical data, and completed the same structured readmission-review rubric used by physicians. In the primary comparative evaluation, 20 randomly selected readmissions from 2025 were each reviewed by two physicians and the AI system. Blinded physician evaluators rated review quality. After rubric refinement, the AI workflow was applied to 100 recent readmissions in an exploratory expanded-cohort analysis of recurring improvement opportunities. Results: In the primary comparative evaluation, the AI classified 9/20 readmissions (45%) as preventable, compared with 19/40 physician reviews (47.5%). Blinded overall quality ratings were similar for AI and physician reviews (4.35 vs. 4.20 on a 1-5 scale; mean difference 0.15, 95% CI -0.20 to 0.48; p=0.49), as were factuality/support and usefulness/actionability ratings. No AI hallucinations were identified during factuality review. Agreement on preventability and primary readmission category was low for both AI-human and human-human comparisons. The AI system cost $0.23 per chart; physician reviewers took a median of 15 minutes, corresponding to an estimated $42.43 per chart. In the exploratory expanded-cohort analysis, AI-assisted review identified recurring vulnerabilities in post-discharge follow-up plans, incomplete inpatient workups, medication-safety transitions, and indwelling-device transitions. Conclusions: Agentic AI produced readmission reviews with similar blinded quality ratings to physician reviews in this small single-center primary comparative evaluation and supported identification of recurring quality-improvement themes in the exploratory expanded-cohort analysis. Preventability judgments remained variable among both AI and physicians, underscoring the need for human oversight and prospective evaluation before operational use.