Ethical approval: This study was reviewed and granted exemption by the institutional review board at the Beth Israel Deaconess Medical Center, including waiver of the requirement of participant informed consent because the data were deidentified. Data sharing: No additional data are available due to data use agreement with the Centers for Medicare and Medicaid Services.
healthcare benchmarks reducing hospital readmissions Manual
The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained. Skip to main content. Research Hospital revisits Article Related content Metrics Responses Peer review. Abstract Objective To determine any changes in total hospital revisits within 30 days of discharge after a hospital stay for medical conditions targeted by the Hospital Readmissions Reduction Program HRRP.
Design Retrospective cohort study. Participants Medicare fee-for-service patients aged 65 or over. Introduction Healthcare systems around the world are intensifying efforts to deliver higher value care. Therefore, in this study, we aimed to answer three policy relevant questions: Have total hospital revisits within 30 days of discharge after a hospital stay for medical conditions targeted by the HRRP changed over time?
Methods Study cohort We used Medicare Provider Analysis and Review files to identify index hospital stays at acute care hospitals from 1 January to 1 October with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia—medical conditions targeted by the HRRP.
Outcomes Our primary outcome was the trend in total hospital revisits within 30 days of discharge after a hospital stay for medical conditions targeted by the HRRP. Statistical analysis Logistic regression was used to fit a model for the outcome of the first post-discharge revisit among patients surviving up to discharge. Patient and public involvement Patients and the public were not involved in planning, design, or interpretation of the study. Table 1 Risk standardized monthly change in hospital revisits, treat-and-discharge visits to an emergency department, observation stays, and readmissions within 30 days of discharge for medical conditions targeted by the HRRP in the US.
View this table: View popup View inline. Fig 1 Risk standardized hospital revisits, treat-and-discharge visits to an emergency department, observation stays, and readmissions within 30 days of discharge for medical conditions targeted by the HRRP in the US. Table 2 Risk standardized monthly change in hospital revisits, treat-and-discharge visits to an emergency department ED , observation stays, and readmissions within 30 days of discharge for medical conditions targeted by the HRRP in the US, categorized by patient subgroups.
Fig 2 Risk standardized mortality within 30 days of discharge among Medicare patients admitted to hospital for heart failure, acute myocardial infarction, or pneumonia medical conditions targeted by the HRRP in the US. Discussion In this study of Medicare beneficiaries admitted to hospital for heart failure, acute myocardial infarction, and pneumonia in the US between and , we found an increase in total hospital revisits within 30 days of discharge despite a reduction in 30 day readmissions.
Strengths and limitations of this study Our study had limitations. Conclusions Although readmissions for target conditions decreased from to in the US, total hospital revisits within 30 days of discharge steadily increased over that same period. What is already known on this topic Readmission rates at 30 days are increasingly used to measure quality of care and evaluate provider and hospital performance under value based payment programs in the United States Readmission rates for medical conditions targeted by one such program, the Hospital Readmissions Reduction Program heart failure, acute myocardial infarction, and pneumonia , have declined modestly on a national scale Policymakers have attributed these reductions to improved discharge planning, care transitions, and post-discharge care after index hospital stays, but these declines could be because clinicians and hospitals have increasingly adopted strategies to manage patients who return to a hospital within 30 days of discharge in emergency departments or as observation stays—which are not included in the current readmission measure.
Strategies to Reduce Hospital Readmission Rates in a Non-Medicaid-Expansion State
The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted Funding: This study received no support from any organization. A roadmap for comparing readmission policies with application to Denmark, England, Germany and the United States.
Health Policy ; : - Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study. BMJ ; : j Readmission rates after passage of the hospital readmissions reduction program: a pre-post analysis. Ann Intern Med ; : - Association of the hospital readmissions reduction program with mortality among medicare beneficiaries hospitalized for heart failure, acute myocardial infarction, and pneumonia.
JAMA ; : - Assessment of strategies for managing expansion of diagnosis coding using risk-adjustment methods for Medicare data. Health Aff Millwood ; 38 : 36 - Association of coded severity with readmission reduction after the hospital readmissions reduction program. JAMA Cardiol ; 2 : - State of the art: emergency department observation units. Crit Pathw Cardiol ; 11 : - Patient financial responsibility for observation care.
J Hosp Med ; 10 : - Early death after discharge from emergency departments: analysis of national US insurance claims data. Association of the Hospital Readmissions Reduction Program implementation with readmission and mortality outcomes in heart failure. JAMA Cardiol ; 3 : 44 - Thirty-day postdischarge mortality among black and white patients 65 years and older in the Medicare Hospital Readmissions Reduction Program.
Payment Incentives: Reducing Hospital Readmissions
HF mortality trends under Medicare Readmissions Reduction Program at penalized and nonpenalized hospitals. J Am Coll Cardiol ; 72 : - Jha AK. To fix the Hospital Readmissions Program, prioritize what matters. JAMA ; : - 3. Thirty-day readmissions--truth and consequences.
N Engl J Med ; : - 9. J Am Coll Cardiol ; 70 : - 4. Gupta A , Fonarow GC. The Hospital Readmissions Reduction Program-learning from failure of a healthcare policy. Eur J Heart Fail ; 20 : - Hospital use of observation stays: cross-sectional study of the impact on readmission rates. Even more, the EDW and analytics applications allowed the team to assess the impact of the interventions on costs and patient satisfaction. The results have been impressive. Just six months after implementing the EDW, the health system achieved:. Reducing readmissions contributes significantly to lowering the overall costs of healthcare in U.
The process is greatly facilitated by analytics applications supported by an enterprise data warehouse to guide improvement projects. These are the keys to developing best practices that will ultimately help hospitals reduce readmissions, and avoid the penalties that result from noncompliance. Would you like to use or share these concepts?
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Explore Health Catalyst Insights. Choose by Topic Latest. The patient-centered medical home PCMH has been gaining traction as a mechanism to improve patient care while reducing health care spending. Skip to main content. Original Research. Reducing hospital readmissions through primary care practice transformation. J Fam Pract.
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ABSTRACT Purpose To assess the impact of a multicomponent intervention on day hospital readmissions in a group of primary care practices that undertook practice transformation, compared with rates in usual-care practices that admitted patients to the same hospital service. Next Article: Who gets sued when heart disease is missed? Practice Management Business of Medicine.
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