Mark A Clapp1, Sarah E Little2, Jie Zheng3, Julian N Robinson2, Anjali J Kaimal4. 1. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA. mark.clapp@mgh.harvard.edu. 2. Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA. 3. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA. 4. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
Abstract
OBJECTIVE: To determine the relative effects of patient and hospital factors on a hospital's postpartum readmission rate. STUDY DESIGN: This retrospective cohort study was conducted using State Inpatient Databases from California, Florida, and New York between 2004 and 2013. We compared patient and hospital characteristics among hospitals with low and high readmission rates using χ2 tests. Risk-adjusted 30-day readmission rates were calculated for patient, delivery, and hospital characteristics to understand factors affecting readmission using fixed and random effects models. RESULTS: Patients in hospitals with low readmission rates were more likely to be white, to have private insurance and higher incomes, and to have fewer comorbidities. The patient comorbidities with the highest risk-adjusted readmission rates included hypertension (range, 2.14-3.04%), obesity (1.78-2.94%), preterm labor/delivery (2.50-2.60%), and seizure disorder (1.78-3.35%). Delivery complications were associated with increased risk-adjusted readmission rates. Compared to patient characteristics, hospital characteristics did not have a profound impact on readmission risk. CONCLUSION: Obstetric readmissions were more attributable to patient and demographic characteristics than to hospital characteristics. Readmission metric-based incentives may ultimately penalize hospitals providing high-quality care due to patient characteristics specific to their catchment area.
OBJECTIVE: To determine the relative effects of patient and hospital factors on a hospital's postpartum readmission rate. STUDY DESIGN: This retrospective cohort study was conducted using State Inpatient Databases from California, Florida, and New York between 2004 and 2013. We compared patient and hospital characteristics among hospitals with low and high readmission rates using χ2 tests. Risk-adjusted 30-day readmission rates were calculated for patient, delivery, and hospital characteristics to understand factors affecting readmission using fixed and random effects models. RESULTS:Patients in hospitals with low readmission rates were more likely to be white, to have private insurance and higher incomes, and to have fewer comorbidities. The patient comorbidities with the highest risk-adjusted readmission rates included hypertension (range, 2.14-3.04%), obesity (1.78-2.94%), preterm labor/delivery (2.50-2.60%), and seizure disorder (1.78-3.35%). Delivery complications were associated with increased risk-adjusted readmission rates. Compared to patient characteristics, hospital characteristics did not have a profound impact on readmission risk. CONCLUSION: Obstetric readmissions were more attributable to patient and demographic characteristics than to hospital characteristics. Readmission metric-based incentives may ultimately penalize hospitals providing high-quality care due to patient characteristics specific to their catchment area.
Authors: Rie Sakai-Bizmark; Hiraku Kumamaru; Dennys Estevez; Sophia Neman; Lauren E M Bedel; Laurie A Mena; Emily H Marr; Michael G Ross Journal: BMJ Qual Saf Date: 2021-06-16 Impact factor: 7.418
Authors: Julia D DiTosto; Can Liu; Elizabeth Wall-Wieler; Ronald S Gibbs; Anna I Girsen; Yasser Y El-Sayed; Alexander J Butwick; Suzan L Carmichael Journal: Am J Obstet Gynecol MFM Date: 2021-03-09