National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 323 Research Studies DisplayedHoffman GJ, Alexander Nb, Ha J
Medicare's hospital readmission reduction program reduced fall-related health care use: an unexpected benefit?
This study’s objective was to assess whether the Medicare Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall-related injuries (FRIs). The authors looked at secondary data from Medicare to assess changes in 30- and 90-day FRI readmissions before and after HRRP's announcement (April 2010) and implementation (October 2012) for conditions targeted by the HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) versus "non-targeted" (gastrointestinal) conditions. They tested for modification by hospitals with "high-risk" before HRRP and accounted for potential upcoding. They also explored changes in 30-day FRI readmissions involving emergency department (ED) or outpatient care, care processes (length of stay, discharge destination, and primary care visit), and patient selection (age and comorbidities). They identified 1.5 million (522,596 pre-HRRP, 514,844 announcement, and 474,029 implementation period) index discharges. After its announcement, HRRP was associated with 12%-20% reductions in 30- and 90-day FRI readmissions for patients with CHF (-0.42 percentage points [ppt]) and AMI (-0.35). Two years after implementation, HRRP was associated with reductions in 90-day FRI readmission for AMI (-1.27 ppt) and CHF (-0.98 ppt) patients. After HRRP's announcement, decreases were observed in home health (AMI: -2.43 ppt; CHF: -8.83 ppt; pneumonia: -1.97 ppt) and skilled nursing facility referrals (AMI: -5.95 ppt; CHF: -3.19 ppt; pneumonia: -10.27 ppt).
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Alexander Nb, Ha J .
Medicare's hospital readmission reduction program reduced fall-related health care use: an unexpected benefit?
Health Serv Res 2024 Feb; 59(1):e14246. doi: 10.1111/1475-6773.14246..
Keywords: Hospital Readmissions, Medicare, Falls
Nash KA, Weerahandi H, Yu H
Measuring equity in readmission as a distinct assessment of hospital performance.
This study examined the measure of equitable readmissions in hospitals as developed by the Centers for Medicare & Medicaid Services (CMS). Objectives were to define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). The authors used data from a cross-section of hospitals who were eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. Of 4638 hospitals, they found that 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of these eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% vs 3.3%, race, 7.6% vs 9.3%), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size. In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions, and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions, and there was no relationship between cost and value, and equity.
AHRQ-funded; HS022882.
Citation: Nash KA, Weerahandi H, Yu H .
Measuring equity in readmission as a distinct assessment of hospital performance.
JAMA 2024 Jan 9; 331(2):111-23. doi: 10.1001/jama.2023.24874..
Keywords: Hospital Readmissions, Hospitals, Provider Performance, Disparities
Lopez K, Li H, Lipkin-Moore Z
Deep learning prediction of hospital readmissions for asthma and COPD.
The purpose of this observational study was to identify Electronic Health Record (EHR) features of severe asthma and COPD exacerbations and assess the performance of four machine learning (ML) and one deep learning (DL) model in predicting readmissions using EHR data. The study included 31, 2017 patients hospitalized with asthma and COPD exacerbations. The study found that Black and Hispanic patients had a greater likelihood of readmission for asthma. Patients with COPD readmissions included a high percentage of Blacks and Hispanics. To identify patients at high risk of readmission, index hospitalization data of a subset of 2,682 patients, 777 with asthma and 1,905 with COPD, was analyzed with four ML models, and one DL model. The researchers discovered that multilayer perceptron, the DL method, had the best sensitivity and specificity compared to the four ML methods implemented in the same dataset.
AHRQ-funded; HS027626.
Citation: Lopez K, Li H, Lipkin-Moore Z .
Deep learning prediction of hospital readmissions for asthma and COPD.
Respir Res 2023 Dec 13; 24(1):311. doi: 10.1186/s12931-023-02628-7..
Keywords: Asthma, Respiratory Conditions, Hospital Readmissions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Parikh K, Lopez MA, Hall M
Child Opportunity Index and rehospitalization for ambulatory care sensitive conditions at US children's hospitals.
Lower Child Opportunity Index (COI) has been related with increased health care use, but the relationship with rehospitalization(s) for ambulatory care sensitive conditions (ACSC) is not known. The purpose of this multicenter retrospective cohort study was to determine the relationship between COI and ACSC rehospitalizations. 184,478 children ages 0 to 17 years with a hospital admission for ambulatory care sensitive conditions in 2017 or 2018 were included. Exposure was COI, and the primary outcome was rehospitalization within 1 year of index admission for ACSC. Of hospitalizations, 28.3% were by children from very low COI and 16.5% were by children from very high COI neighborhoods. In risk-adjusted models, ACSC rehospitalization was higher for children from very low COI than very high COI neighborhoods; any rehospitalization occurred for 18.7% from very low COI and 13.5% from very high COI neighborhoods whereas 2 or more rehospitalization occurred for 4.8% from very low COI and 3.2% from very high COI neighborhoods.
AHRQ-funded; HS024554; HS028484; HS026385.
Citation: Parikh K, Lopez MA, Hall M .
Child Opportunity Index and rehospitalization for ambulatory care sensitive conditions at US children's hospitals.
Hosp Pediatr 2023 Nov; 13(11):1028-37. doi: 10.1542/hpeds.2023-007279..
Keywords: Children/Adolescents, Hospital Readmissions, Hospitals, Ambulatory Care and Surgery
Ryus CR, Janke AT, Kunnath N
Association of hospital discharge against medical advice and coded housing instability in the US.
This study examined the relationship between discharge type and housing instability, then identified primary reasons for hospitalization among self-discharged patients with housing instability. This cross-sectional, retrospective study analyzed the National Inpatient Sample between January 2017 and December 2019, available from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project. Among 85,402,831 hospitalizations analyzed, 1.6% resulted in self-discharge. Compared to admissions with planned discharges, self-discharges were more likely to have coded housing instability. Among hospitalizations resulting in self-discharge, admissions with coded housing instability were more likely to result in self-discharge than those without coded housing instability. Relationships between housing instability and self-discharges were found among major medical conditions: septicemia, acute myocardial infarction, and respiratory failure. Alcohol-related disorders and opioid-related disorders were among the highest self-discharge volumes, but relationships were minimal.
AHRQ-funded; HS028963.
Citation: Ryus CR, Janke AT, Kunnath N .
Association of hospital discharge against medical advice and coded housing instability in the US.
J Gen Intern Med 2023 Oct; 38(13):3082-85. doi: 10.1007/s11606-023-08240-1..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Social Determinants of Health, Vulnerable Populations, Hospital Readmissions
Dekeyser GJ, Martin BI, Marchand LS
Geriatric distal femur fractures treated with distal femoral replacement are associated with higher rates of readmissions and complications.
The objective of this study was to compare mortality and complications of distal femur fracture repair among elderly patients who received operative fixation versus distal femur replacement (DFR). Participants were Medicare beneficiaries aged 65 and older with distal femur fracture who were identified using Center for Medicare & Medicaid Services data. Most of the patients received operative fixation surgery. Results indicated that DFR was associated with significantly greater rates of infection, device-related complication, pulmonary embolism, deep vein thrombosis, costs, and readmission.
AHRQ-funded; HS024714.
Citation: Dekeyser GJ, Martin BI, Marchand LS .
Geriatric distal femur fractures treated with distal femoral replacement are associated with higher rates of readmissions and complications.
J Orthop Trauma 2023 Oct; 37(10):485-91. doi: 10.1097/bot.0000000000002638..
Keywords: Elderly, Injuries and Wounds, Hospital Readmissions, Adverse Events
Squires A, Engel P, Ma C
Continuity of care versus language concordance as an intervention to reduce hospital readmissions from home health care.
The purpose of this study was to examine the relative effectiveness of continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. Participants included over 22,000 non-English-speaking patients from the New York City area who were admitted to their home health site following hospital discharge. Findings revealed that high continuity of care and high language concordance significantly decreased readmissions, along with high continuity of care and low language concordance; low continuity of care and high language concordance did not significantly impact readmissions. The authors concluded that enhancing continuity of care for those with language barriers the US home health system may help to address disparities and reduce hospital readmission rates.
AHRQ-funded; HS023593.
Citation: Squires A, Engel P, Ma C .
Continuity of care versus language concordance as an intervention to reduce hospital readmissions from home health care.
Med Care 2023 Sep; 61(9):605-10. doi: 10.1097/mlr.0000000000001884..
Keywords: Hospital Readmissions, Transitions of Care, Home Healthcare
Howell TC, Lumpkin S, Chaumont N
Predicting colorectal surgery readmission risk: a surgery-specific predictive model.
The purpose of this retrospective split-sample cohort study was to develop a predictive model for colorectal surgery patients for risk of 30-day readmission. The researchers included patients admitted to the colorectal surgery service who underwent surgery and were discharged from an academic tertiary hospital between 2017 and 2019. A total of 1549 patients met eligibility criteria. The study found the 30-day readmission rate of the cohort was 19.62%. Customized surgery-specific readmission models with comprehensive data sources outperformed the most utilized readmission indices in predicting 30-day readmission in colorectal surgery patients. The performance of the models were improved by utilizing more comprehensive datasets that include administrative and socioeconomic details about a patient and clinical information utilized for decision-making at the time of discharge.
AHRQ-funded; HS026363.
Citation: Howell TC, Lumpkin S, Chaumont N .
Predicting colorectal surgery readmission risk: a surgery-specific predictive model.
IISE Trans Healthc Syst Eng 2023; 13(3):175-81. doi: 10.1080/24725579.2023.2200210..
Keywords: Hospital Readmissions, Surgery, Risk
Brajcich BC, Johnson JK, Holl JL
Evaluation of emergency department treat-and-release encounters after major gastrointestinal surgery.
The purpose of this study was to assess the incidence of, reasons for, and predictors of emergency department treat-and-release encounters after gastrointestinal cancer operations. The researchers identified patients who underwent elective colorectal, esophageal, gastric, hepatobiliary, pancreatic, or small intestinal operations for cancer from the 2015-2017 Healthcare Cost and Utilization Project State Inpatient and State Emergency Department Databases for New York, Maryland, and Florida. The study found that among 51,527 patients at 406 hospitals, 7.9% had an ED treat-and-release encounter, and 10.8% had an ED encounter with readmission. In total, 40.7% of ED encounters were treat-and-release encounters. 12% of ED treat-and-release encounters were for pain, 11.7% for device/ostomy complaints, and 11.4% were for wound complaints (11.4%). ED treat-and-release encounters predictors included non-Hispanic Black race/ethnicity and Medicare or Medicaid coverage.
AHRQ-funded; HS026385.
Citation: Brajcich BC, Johnson JK, Holl JL .
Evaluation of emergency department treat-and-release encounters after major gastrointestinal surgery.
J Surg Oncol 2023 Aug; 128(2):402-08. doi: 10.1002/jso.27292..
Keywords: Emergency Department, Digestive Disease and Health, Surgery, Hospital Readmissions
Congdon M, Rauch B, Carroll B
Opportunities for diagnostic improvement among pediatric hospital readmissions.
The purpose of this retrospective cohort study was to: 1) identify and describe diagnostic errors, termed "missed opportunities for improving diagnosis" (MOIDs) in general pediatric patients who experienced hospital readmission, 2) outline improvement opportunities, and 3) explore factors associated with increased risk of MOID. The researchers included unplanned readmissions within 15 days of discharge from a freestanding children's hospital between October 2018 and September 2020. Health records were reviewed and discussed by practicing inpatient physicians to identify MOIDs using SaferDx, an established instrument. MOIDs were evaluated using a diagnostic-specific tool to identify improvement opportunities within the diagnostic process. The study found that MOIDs were identified in 6.3% of 348 readmissions. Opportunities for improvement included: delay in considering the correct diagnosis (50%) and failure to order needed test (45%). Patients with MOIDs were older than patients without MOIDs but similar in gender, primary language, race, ethnicity, and insurance type. The researchers did not identify conditions related with higher risk of MOID. Lower respiratory tract infections accounted for 26% of admission diagnoses but only 1 (4.5%) case of MOID.
AHRQ-funded; HS028682.
Citation: Congdon M, Rauch B, Carroll B .
Opportunities for diagnostic improvement among pediatric hospital readmissions.
Hosp Pediatr 2023 Jul; 13(7):563-71. doi: 10.1542/hpeds.2023-007157..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Hospitals, Hospital Readmissions
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N and Rodrick D
Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality and readmission for patients with heart failure.
Researchers sought to evaluate the association between hospital performance on mortality and readmission with hospital performance on safety adverse event rates. Their cross-sectional study linked patient-level adverse events data from the Medicare Patient Safety Monitoring System to hospital-level, heart failure (HF)-specific, 30-day, all-cause mortality and readmissions data from CMS. The study included data on over 39,000 patients with HF from over 3000 hospitals. Patients admitted with HF to hospitals with high 30-day, all-cause mortality and readmission rates had a higher risk of in-hospital adverse events. The researchers concluded that there might be common quality issues among the measure concepts in these hospitals that produce poor performance for patients with HF.
AHRQ-funded; AHRQ-authored; 290201800005C.
Citation: Wang Y, Eldridge N, Metersky ML .
Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality and readmission for patients with heart failure.
Circ Cardiovasc Qual Outcomes 2023 Jul; 16(7):e009573. doi: 10.1161/circoutcomes.122.009573..
Keywords: Hospitals, Hospital Readmissions, Heart Disease and Health, Cardiovascular Conditions, Adverse Events, Provider Performance
Arbaje AI, Woodman S, Keita Fakeye MB
Senior services in US hospitals and readmission risk or mortality among Medicare beneficiaries since the Affordable Care Act.
This study examined whether there was an association between readmission risk or mortality among Medicare beneficiaries and passage of the Affordable Care Act. The study updated the Senior Care Services Scale (SCSS) which describes hospital provision of older adult services before the passage of the Affordable Care Act. The authors conducted a retrospective cohort analysis of older adults ≥65 years (n = 1,416,669), admitted to 2570 US acute-care hospitals from 2014 to 2015. Outcomes were hospital readmission, or death, within 30 and 90 days of discharge. The updated SCSS included three service groups: Inpatient Specialty Care, Post-Acute Community Care, and Home Care and Hospice. Older adults admitted to high Inpatient-Specialty-Care-scoring hospitals had lower risk of death within 30 days, and 90 days. There was no significant association between the other two groups and study outcomes.
AHRQ-funded; HS022916.
Citation: Arbaje AI, Woodman S, Keita Fakeye MB .
Senior services in US hospitals and readmission risk or mortality among Medicare beneficiaries since the Affordable Care Act.
J Appl Gerontol 2023 Jul; 42(7):1424-32. doi: 10.1177/07334648231161925..
Keywords: Elderly, Hospitals, Hospital Readmissions, Medicare
Loomer L, Rahman M, Mroz TM
Impact of higher payments for rural home health episodes on rehospitalizations.
This article evaluated the impact of higher Medicare payments for rural home health care on rehospitalizations. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries. The authors used Medicare data on postacute HH episodes from 2007 to 2014 to estimate the impact of higher payments on beneficiaries outcomes using difference-in-differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010. Their sample included 5.6 million post acute HH episodes (18% rural). After 2010 30- and 60-day rehospitalization rates declined by 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference-in-difference estimate was 0.29 percentage points and 0.57 percentage points for 30- and 60-day rehospitalization, respectively.
AHRQ-funded; HS027054.
Citation: Loomer L, Rahman M, Mroz TM .
Impact of higher payments for rural home health episodes on rehospitalizations.
J Rural Health 2023 Jun; 39(3):604-10. doi: 10.1111/jrh.12725..
Keywords: Payment, Rural Health, Rural/Inner-City Residents, Hospital Readmissions, Hospitalization
Meddings J, Gibbons JB, Reale BK
The impact of nurse practitioner care and accountable care organization assignment on skilled nursing services and hospital readmissions.
The purpose of this study was to determine the relationship between Accountable Care Organizations (ACO) designation and nurse practitioners (NP) care delivery during skilled nursing facilities (SNF) visits and the relationship between NP care delivery during SNF visits and unplanned hospital readmissions. The researchers obtained a sample of 527,329 fee-for-service Medicare beneficiaries with 1 or more SNF stays between 2012 and 2017 and then measured the association between patient ACO designation and evaluation and management care delivered by NPs in addition to the association between evaluation and management services delivered by NPs and hospital readmissions. The study found that ACO beneficiaries were 1.26% points more likely to receive 1 or more E&M services delivered by an NP during their SNF visits. ACO-designated beneficiaries receiving most of their E&M services from NPs during their SNF visits were at a lower risk of readmission than ACO-attributed beneficiaries receiving no NP E&M care.
AHRQ-funded; HS024698.
Citation: Meddings J, Gibbons JB, Reale BK .
The impact of nurse practitioner care and accountable care organization assignment on skilled nursing services and hospital readmissions.
Med Care 2023 Jun; 61(6):341-48. doi: 10.1097/mlr.0000000000001826..
Keywords: Nursing, Provider: Nurse, Hospital Readmissions, Provider: Clinician
Ray EM, Hinton SP, Reeder-Hayes KE
Risk factors for return to the emergency department and readmission in patients with hospital-diagnosed advanced lung cancer.
The objectives of this study were to examine the patterns of care and risk factors for subsequent acute care utilization among patients with hospital-diagnosed advanced lung cancer (ALC). Researchers identified patients with incident ALC from 2007-13 and an index hospitalization within 7 days of diagnosis in Surveillance, Epidemiology, and End Results-Medicare. Results showed that more than half of the incident ALC patients were hospitalized around the time of diagnosis; among those who survived to discharge, only 37% received systemic cancer treatment. Many patients experienced an early readmittance and most died within 6 months. The researchers conclude that such patients may benefit from increased access to palliative and other supportive care during hospitalization to prevent subsequent health care utilization.
AHRQ-funded; HS000032.
Citation: Ray EM, Hinton SP, Reeder-Hayes KE .
Risk factors for return to the emergency department and readmission in patients with hospital-diagnosed advanced lung cancer.
Med Care 2023 Apr;61(4):237-46. doi: 10.1097/mlr.0000000000001829.
Keywords: Emergency Department, Hospital Readmissions, Cancer: Lung Cancer, Cancer, Risk
Rich KM, Guardado R, Bigham ZR
The impact of incarceration on readmissions among patients with inflammatory bowel disease hospitalized at a community hospital.
The purpose of this study was to compare the frequency of readmissions in patients with inflammatory bowel disease (IBD) receiving care at a community hospital who were and were not incarcerated when they were hospitalized. The primary study outcome was all cause readmission at 1 year following an IBD-related admission. The secondary outcomes included 1. all-cause readmission at 30 days, 2. IBD-related readmission at 30 days, and 3. IBD-related readmission at 1 year. The study indicator of interest was incarceration. The study found that individuals who were incarcerated had a greater rate of all-cause readmissions at 1 year than those who were not incarcerated at the time of hospitalization.
AHRQ-funded; HS026008.
Citation: Rich KM, Guardado R, Bigham ZR .
The impact of incarceration on readmissions among patients with inflammatory bowel disease hospitalized at a community hospital.
Gastro Hep Advances 2023; 2(5):660-65..
Keywords: Vulnerable Populations, Hospital Readmissions, Access to Care
Difazio RL, Shore BJ, Melvin P
Pneumonia after hip surgery in children with neurological complex chronic conditions.
The purpose of this retrospective cohort study was to estimate rates of postoperative pneumonia in children with neurological complex chronic conditions (CCC) undergoing hip surgery, to determine the effect of pneumonia on postoperative hospital resource use, and to identify predictors. Researchers used data from the Pediatric Health Information System for children 4 years and older with a neurological CCC who had undergone hip surgery from 2016 to 2018 in U.S. children's hospitals. Findings indicate that postoperative pneumonia in children with a neurological CCC was associated with longer length-of-stay, readmissions, and higher costs. Children who had undergone pelvic osteotomies and who had multimorbidity needed additional clinical support to prevent postoperative pneumonia and to decrease resource utilization.
AHRQ-funded; HS024453.
Citation: Difazio RL, Shore BJ, Melvin P .
Pneumonia after hip surgery in children with neurological complex chronic conditions.
Dev Med Child Neurol 2023 Feb; 65(2):232-42. doi: 10.1111/dmcn.15339..
Keywords: Children/Adolescents, Surgery, Neurological Disorders, Pneumonia, Respiratory Conditions, Hospital Readmissions, Adverse Events
Aswani MS, Roberts ET
Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions.
The objective of this study was to investigate the limitations of peer grouping and associated challenges in the measurement of social risk in Medicare's Hospital Readmission Reduction Program (HRRP). Public data on hospitals in the HRRP were used to examine the relationship between hospital dual share and readmission rates within peer groups as well as changes in hospital peer group assignments, readmission rates, and penalties, and the relationship between state Medicaid eligibility rules and peer groups. The findings indicated that peer grouping is limited in the extent to which it accounts for differences in hospitals' patient populations. The authors concluded that problems arise from the construction of peer groups and the measure of social risk used to define them.
AHRQ-funded; HS026727.
Citation: Aswani MS, Roberts ET .
Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions.
Health Serv Res 2023 Feb; 58(1):51-59. doi: 10.1111/1475-6773.13969..
Keywords: Hospital Readmissions, Hospitals, Risk
Rojas JC, Chokkara S, Zhu M
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
The purpose of this study was to assess changes in the quality of care for patients hospitalized for Chronic obstructive pulmonary disease (COPD) after the implementation of the Hospital Readmissions Reduction Program (HRRP) which levied financial penalties on hospitals for excessive COPD readmissions. The researchers reviewed the records from 995 U.S. hospitals in the Premier Healthcare Database, evaluating patients older than 40 years of age hospitalized for COPD. The study included 662,842 pre-HRRP (January 2010-September 2014) and 285,508 post-HRRP (October 2014-December 2018) admissions, and found that recommended care increased at a rate of 0.16% per month pre-HRRP and 0.01% per month post-HRRP. Nonrecommended care decreased at a rate of 0.15% per month pre-HRRP and 0.13% per month post-HRRP. Ideal care increased at a rate of 0.24% per month pre-HRRP and 0.11% per month post-HRRP. The researchers concluded that after HRRP implementation, the pre-HRRP trends toward improving care quality for inpatient COPD care slowed.
AHRQ-funded; HS027804.
Citation: Rojas JC, Chokkara S, Zhu M .
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
Am J Respir Crit Care Med 2023 Jan; 207(1):29-37. doi: 10.1164/rccm.202203-0496OC..
Keywords: Respiratory Conditions, Quality of Care, Hospital Readmissions, Chronic Conditions
Collins CR, Abel MK, Shui A
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
This study aimed to assess where the largest opportunities for care improvement lay with the bundled payment reimbursement model and how best to identify patients at high risk of suffering costly complications, including hospital readmission. The authors used a cohort of patients from 2014 and 2016 who met inclusion criteria for the Major Bowel Bundled Payment Program and performed a cost analysis to identify opportunities for improved care efficiency. Using the results, they identified readmissions as a target for improvement and then assessed whether the American College of Surgeons' National Surgical Quality Improvement Program surgical risk calculator (ACS NSQIP SRC) could accurately identify patients within the bundled payment population who were at high risk of readmission using a logistic regression model. Patients who were readmitted within 90-days post-surgery were 2.53 times more likely to be high-cost (>$60,000) then non-readmitted patients. However, the ACS NSQIP SRC did not accurately predict patients at high risk of readmission within the first 30 days post-surgery.
AHRQ-funded; HS024532.
Citation: Collins CR, Abel MK, Shui A .
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
Perioper Med 2022 Dec 9;11(1):54. doi: 10.1186/s13741-022-00286-9..
Keywords: Provider Performance, Payment, Hospital Readmissions, Quality Improvement, Quality of Care, Surgery, Medicare, Medicaid
Anderson TS, Marcantonio ER, McCarthy EP
Association of diagnosed dementia with post-discharge mortality and readmission among hospitalized Medicare beneficiaries.
The purpose of this retrospective cohort study was to examine whether patients with dementia have a higher risk of adverse outcomes post-discharge. The researchers included Medicare beneficiaries hospitalized in 2016 and evaluated the co-primary outcomes of mortality and readmission within 30 days of hospital discharge. The final cohort included 1,089,109 hospitalizations of which 19.3% were of patients with diagnosed dementia and 886,411 were of patients without dementia. The study found that at 30 days following discharge, 5.7% of patients with dementia had died compared to 3.1% of patients without dementia. At 30 days following discharge, 17.7% of patients with dementia had been readmitted compared to 13.1% of patients without dementia. Patients with dementia who were discharged to the community had an increased likelihood of being readmitted than those who were discharged to nursing facilities, and, when readmitted, had an increased likelihood of dying during the readmission. The study concluded that diagnosed dementia was related with a substantially increased risk of mortality and a modestly increased risk of readmission within 30 days of discharge.
AHRQ-funded; HS026215.
Citation: Anderson TS, Marcantonio ER, McCarthy EP .
Association of diagnosed dementia with post-discharge mortality and readmission among hospitalized Medicare beneficiaries.
J Gen Intern Med 2022 Dec;37(16):4062-70. doi: 10.1007/s11606-022-07549-7..
Keywords: Dementia, Neurological Disorders, Medicare, Elderly, Hospital Readmissions, Mortality
Keeney T, Lee Lee, Basford JR
Association of function, symptoms, and social support reported in standardized outpatient clinic questionnaires with subsequent hospital discharge disposition and 30-day readmissions.
The objective of this retrospective cohort study was to determine whether patient-reported information which is routinely collected in an outpatient setting was associated with hospital readmission within 30 days of discharge; the need for post-acute care after a subsequent hospital admission was also examined. Participants were patients hospitalized between May 2004 and May 2014 in a Midwestern health system. Six domains of patient-reported information were collected in outpatient clinic settings and linked to electronic health record hospitalization data. These domains were found to be significantly associated with 30-day readmission and placement in a facility. The authors concluded that further research is needed to determine whether these data can be leveraged to guide interventions to address patient needs and improve outcomes.
AHRQ-funded; HS000011.
Citation: Keeney T, Lee Lee, Basford JR .
Association of function, symptoms, and social support reported in standardized outpatient clinic questionnaires with subsequent hospital discharge disposition and 30-day readmissions.
Arch Phys Med Rehabil 2022 Dec;103(12):2383-90. doi: 10.1016/j.apmr.2022.06.004..
Keywords: Hospital Discharge, Hospital Readmissions
Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
This retrospective cohort study sought to determine the relationship between a patient's proximal familial social support, defined as the geographic proximity of family members, and healthcare utilization after complex cardiovascular and oncologic procedures. The authors defined healthcare utilization outcomes as 30-day all-cause readmission unplanned readmission, nonindex hospital readmission, index hospital length of stay, and home discharge disposition. The number of first-degree relatives (FDRs) living within 30 miles of the patient was measured using 60,895 patients undergoing complex cardiovascular procedures or oncologic procedures. Compared with patients with 0 to 1 FDRs, patients with 6+ FDRs living in close proximity had significantly lower rates of all-cause readmission (12.1% vs 13.5%), unplanned readmission, nonindex readmission; higher rates of home discharge. A larger number of FDRs living within 30 miles of the patient was significantly associated with a lower likelihood of all-cause readmission, 30-day unplanned readmission, nonindex readmission; higher likelihood of home discharge; and shorter index length of stay.
AHRQ-funded; HS025776.
Citation: Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R .
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
Ann Surg 2022 Oct 1;276(4):720-31. doi: 10.1097/sla.0000000000005584..
Keywords: Surgery, Hospital Discharge, Hospital Readmissions, Healthcare Utilization
Odeh Couvertier V, Patterson Patterson, Zayas-Cabán G
Association between advanced image ordered in the emergency department on subsequent imaging for abdominal pain patients.
The purpose of this retrospective, observational study was to evaluate abdominal pain patients discharged from the ED to determine the association between advanced emergency department (ED) imaging on subsequent outpatient imaging and on revisits. The researchers utilized the electronic health records of Medicare patients who presented with a complaint of abdominal pain at a United States academic emergency department. The study found that participants who were not imaged at the ED had significantly higher adjusted odds of being imaged outside of the ED within 7, 14, and 28 days of being discharged, and had a significantly higher adjusted odds of returning to the study ED and visiting any ED within 30 days of being discharged. The study concluded that receiving abdominal imaging services in the ED was related with significantly lower imaging use after discharge.
AHRQ-funded; HS024558.
Citation: Odeh Couvertier V, Patterson Patterson, Zayas-Cabán G .
Association between advanced image ordered in the emergency department on subsequent imaging for abdominal pain patients.
Acad Emerg Med 2022 Sep;29(9):1078-83. doi: 10.1111/acem.14541..
Keywords: Imaging, Emergency Department, Diagnostic Safety and Quality, Hospital Readmissions
Rogstad TL, Gupta S, Connolly J
Social risk adjustment In the hospital readmissions reduction program: a systematic review and implications for policy.
Investigators reviewed fourteen studies of social risk adjustment in Medicare's Hospital Readmissions Reduction Program (HRRP). They concluded that their findings support the use of social risk adjustment to improve provider payment equity and highlight opportunities to enhance social risk adjustment in value-based payment programs.
AHRQ-funded; HS026727.
Citation: Rogstad TL, Gupta S, Connolly J .
Social risk adjustment In the hospital readmissions reduction program: a systematic review and implications for policy.
Health Aff 2022 Sep;41(9):1307-15. doi: 10.1377/hlthaff.2022.00614..
Keywords: Social Determinants of Health, Hospital Readmissions, Risk, Policy