Chih-Ying Li1, Amol Karmarkar2, Yu-Li Lin3, Yong-Fang Kuo4, Kenneth J Ottenbacher5. 1. Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX. Electronic address: chili@utmb.edu. 2. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX. 3. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX. 4. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX. 5. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX.
Abstract
OBJECTIVES: Examine whether the introduction of the Hospital Readmissions Reduction Program (HRRP) is associated with changes in post-acute care (PAC) use and 30-day readmission. DESIGN: A retrospective cohort study examined data prepassage, preimplementation, and postimplementation of the HRRP. SETTING AND PARTICIPANTS: In total, 7,851,430 Medicare beneficiaries discharged from 5116 acute hospitals to PAC settings including inpatient rehabilitation, skilled nursing, home health, or a long-term care hospital during 2007‒2015. We examined HRRP-targeted conditions (acute myocardial infarction, heart failure, and pneumonia) and nontargeted conditions (ischemic stroke, total hip arthroplasty/total knee arthroplasty, and hip/femur fractures). MEASURES: The hospital-level of quarterly PAC use and the association with 30-day risk-standardized readmission rates. Outcomes were calculated for HRRP-targeted and nontargeted conditions/diagnoses across 3 phases of HRRP implementation. RESULTS: An increase in quarterly PAC use was significantly (P < .001) associated with a decrease in 30-day risk-standardized readmission rates for acute myocardial infarction, heart failure, and hip/femur fracture. In contrast, an increase in quarterly PAC use was significantly associated with an increase in readmission rate for total hip arthroplasty/total knee arthroplasty (P < 001). PAC quarterly use and readmission rates varied significantly during implementation periods for HRRP- targeted and nontargeted conditions. CONCLUSIONS AND IMPLICATIONS: The impact on readmission after PAC for selected impairment groups may be mediated by the type of PAC services received and whether the diagnoses is included in the HRRP. Additional research is necessary to determine if a reduction in readmission is associated with inclusion in the HRRP or is a side effect related to diagnostic group and/or type of PAC services received.
OBJECTIVES: Examine whether the introduction of the Hospital Readmissions Reduction Program (HRRP) is associated with changes in post-acute care (PAC) use and 30-day readmission. DESIGN: A retrospective cohort study examined data prepassage, preimplementation, and postimplementation of the HRRP. SETTING AND PARTICIPANTS: In total, 7,851,430 Medicare beneficiaries discharged from 5116 acute hospitals to PAC settings including inpatient rehabilitation, skilled nursing, home health, or a long-term care hospital during 2007‒2015. We examined HRRP-targeted conditions (acute myocardial infarction, heart failure, and pneumonia) and nontargeted conditions (ischemic stroke, total hip arthroplasty/total knee arthroplasty, and hip/femur fractures). MEASURES: The hospital-level of quarterly PAC use and the association with 30-day risk-standardized readmission rates. Outcomes were calculated for HRRP-targeted and nontargeted conditions/diagnoses across 3 phases of HRRP implementation. RESULTS: An increase in quarterly PAC use was significantly (P < .001) associated with a decrease in 30-day risk-standardized readmission rates for acute myocardial infarction, heart failure, and hip/femur fracture. In contrast, an increase in quarterly PAC use was significantly associated with an increase in readmission rate for total hip arthroplasty/total knee arthroplasty (P < 001). PAC quarterly use and readmission rates varied significantly during implementation periods for HRRP- targeted and nontargeted conditions. CONCLUSIONS AND IMPLICATIONS: The impact on readmission after PAC for selected impairment groups may be mediated by the type of PAC services received and whether the diagnoses is included in the HRRP. Additional research is necessary to determine if a reduction in readmission is associated with inclusion in the HRRP or is a side effect related to diagnostic group and/or type of PAC services received.
Authors: Andrew M Ibrahim; Justin B Dimick; Shashank S Sinha; John M Hollingsworth; Ushapoorna Nuliyalu; Andrew M Ryan Journal: JAMA Intern Med Date: 2018-02-01 Impact factor: 21.873
Authors: Jason H Wasfy; Corwin Matthew Zigler; Christine Choirat; Yun Wang; Francesca Dominici; Robert W Yeh Journal: Ann Intern Med Date: 2016-12-27 Impact factor: 25.391