For-Profit Hospital Status and Rehospitalizations at Different Hospitals: An Analysis of Medicare Data

Kind, Amy; Bartels, Christie M.; Mell, Matthew W.; Mullahy, John; Smith, Maureen A.

doi:10.7326/0003-4819-153-11-201012070-00005

Cited by 58 publications

(79 citation statements)

References 38 publications

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“…First, without access to claims data, we assess utilization only within CHA's network; we do not observe out-of-network readmissions, estimated to comprise 20 % of all readmissions. 52 We expected that nonnetwork readmissions would occur equally between intervention and control patients; however, even a small imbalance in unobserved out-of-network rehospitalizations might render our estimated reductions in readmissions among older patients nonsignificant. On the other hand, a positive experience with a PN might have led some intervention patients to selectively choose a CHA hospital for readmission; in this case, our readmission reductions with the older population may actually be underestimated.…”

Section: Discussionmentioning

confidence: 88%

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

et al. 2015

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BACKGROUND: Evidence-based interventions to reduce hospital readmissions may not generalize to resourceconstrained safety-net hospitals. OBJECTIVE: To determine if an intervention by patient navigators (PNs), hospital-based Community Health Workers, reduces readmissions among high risk, low socioeconomic status patients. DESIGN: Randomized controlled trial. PARTICIPANTS: General medicine inpatients having at least one of the following readmission risk factors: (1) age≥60 years, (2) any in-network inpatient admission within the past 6 months, (3) length of stay≥3 days, (4) admission diagnosis of heart failure, or (5) chronic obstructive pulmonary disease. The analytic sample included 585 intervention patients and 925 controls. INTERVENTIONS: PNs provided coaching and assistance in navigating the transition from hospital to home through hospital visits and weekly telephone outreach, supporting patients for 30 days post-discharge with discharge preparation, medication management, scheduling of follow-up appointments, communication with primary care, and symptom management. MAIN MEASURES: The primary outcome was in-network 30-day hospital readmissions. Secondary outcomes included rates of outpatient follow-up. We evaluated outcomes for the entire cohort and stratified by patient age >60 years (425 intervention/584 controls) and ≤60 years (160 intervention/341 controls). KEY RESULTS: Overall, 30-day readmission rates did not differ between intervention and control patients. However, the two age groups demonstrated marked differences. Intervention patients >60 years showed a statistically significant adjusted absolute 4.1 % decrease [95 % CI: −8.0 %, -0.2 %] in readmission with an increase in 30-day outpatient follow-up. Intervention patients ≤60 years showed a statistically significant adjusted absolute 11.8 % increase [95 % CI: 4.4 %, 19.0 %] in readmission with no change in 30-day outpatient follow-up. CONCLUSIONS: A patient navigator intervention among high risk, safety-net patients decreased readmission among older patients while increasing readmissions among younger patients. Care transition strategies should be evaluated among diverse populations, and younger high risk patients may require novel strategies.KEY WORDS: care transitions; continuity of care; health care delivery; patient safety; underserved populations. J Gen Intern Med 30(7):907-15

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Section: Discussionmentioning

confidence: 88%

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

et al. 2015

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“…Among patients readmitted within 30 days, 769 patients (22.6%) were readmitted to a different hospital than where they were initially discharged, and 2,630 patients (77.4%) were readmitted to the same hospital ( 4.70] for facility, respectively). Year of diagnosis, SEER site, and length of stay at index hospital were included in the multivariate regressions, and all were nonsignificant (P , .05).…”

Section: Resultsmentioning

confidence: 99%

Readmissions After Colon Cancer Surgery: Does It Matter Where Patients Are Readmitted?

Luu

Hussain

Chang

et al. 2016

JOP

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QUESTION ASKED: Do mortality and cost differ for patients with cancer who get readmitted to the hospital within 30 days after their initial cancer surgery on the basis of whether they are admitted to the same hospital where they had their surgery or to a different hospital?SUMMARY ANSWER: Patients with colon cancer who had a 30-day readmission to a different hospital than the one where they received their cancer surgery did not experience higher all-cause mortality, colon cancer-specific mortality, or costs compared with patients who were readmitted to the hospital where they underwent their cancer surgery. However, patients readmitted to a different hospital did have a higher risk of short-term (90-day) mortality. METHODS:We used SEER-Medicare linked data of patients with colon cancer diagnosed between 2000 and 2009. Our cohort consisted of patients with stage I to III disease who received colon cancer surgery and were subsequently readmitted within 30 days of their initial discharge. We compared patients who were readmitted to the same hospital as where their surgery was performed and those admitted to a different hospital. We performed propensity score-weighted doubly robust models to examine the association with all-cause mortality, cancer-specific mortality, 90-day all-cause mortality, 90-day cancer-specific mortality, and costs (Table 2). Our models were adjusted for patient, physician, and hospital characteristics. We used Cox proportional hazard models for all-cause mortality, the method of Fine and Gray for competing risk regression for colon cancer-specific mortality, and log transformed generalized linear models with gamma distribution to model costs. BIAS/CONFOUNDING FACTOR(S), DRAWBACKS:The choice of both the initial hospital where patients received surgery and the subsequent hospital where they were readmitted is unlikely to be random. Though we used propensity score adjusted models, we were unable to account for the reasons why patients selected one hospital versus another and were unable to assess factors such as travel distance. In addition, we were unable to determine whether hospitals were part of an integrated network, which may bias our findings toward the null. Finally, the generalizability of our sample is limited to Medicare fee-for-service beneficiaries and to patients who were not transferred during their initial hospital admission. REAL-LIFE IMPLICATIONS:Readmission after cancer surgery is a costly problem, and a large number of clinical initiatives and policy efforts have centered on reducing rates of readmission. Less attention has been focused on whether it matters where patients get readmitted. We were concerned that patients who are readmitted to a different hospital from where they received their cancer surgery may be more likely to experience poorly coordinated and costly care and be subject to poor outcomes. We focus on readmissions after colon cancer, the third most common cancer and one for which surgery is the cornerstone of treatment of patients with stage I to III disease....

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“…19 It is possible that factors that best predict readmissions may be nonmedical and unrelated to disease severity, 20 may be related to patient safety climate and patient satisfaction, 21,22 or may be affected by hospital location and patient race. 23 However, clinical and health-related factors such as malnutrition appear to predict and affect hospital readmission rates.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Acute Care Hospitals Have Low Impact on Medicare Readmissions to Short-Term Acute Care Hospitals

Grigonis¹,

Snyder²,

Dawson³

2013

Am J Med Qual

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The relative contribution of long-term acute care hospital (LTACH) to short-term acute care hospital (STACH) Medicare patient readmissions is important because of the high acuity of LTACH patients. A retrospective cohort study was conducted to determine the magnitude of LTACH Medicare heart failure (HF) and pneumonia (PN) inpatient readmissions to STACHs within 30 days of LTACH admission and the relative contribution of LTACH patient readmissions to each STACH's total readmissions. Seventy-five for-profit LTACHs and their associated host or primary referral STACHs were studied. An average of 8% HF and 8% PN LTACH Medicare inpatients were readmitted to host or primary referral STACHs within 30 days of admission, representing 0.4% and 0.8% of the total number of HF and PN Medicare patients, respectively, readmitted to the STACHs in fiscal year 2010. The low rates of readmission from LTACHs to STACHs suggest an appropriate level of care for the LTACHs studied.

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For-Profit Hospital Status and Rehospitalizations at Different Hospitals: An Analysis of Medicare Data

Cited by 58 publications

References 38 publications

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

Readmissions After Colon Cancer Surgery: Does It Matter Where Patients Are Readmitted?

Long-Term Acute Care Hospitals Have Low Impact on Medicare Readmissions to Short-Term Acute Care Hospitals

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