Limits Of Readmission Rates In Measuring Hospital Quality Suggest The Need For Added Metrics

Press, Matthew J.; Scanlon, Dennis P.; Ryan, Andrew M.; Zhu, Jingsan; Navathe, Amol S.; Mittler, Jessica; Volpp, Kevin G.

doi:10.1377/hlthaff.2012.0518

Cited by 64 publications

(55 citation statements)

References 33 publications

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“…Our findings have important implications as health care models shift toward services that are preventative and population health based. 16,17 Because infant rehospitalization and ED visits were associated with maternal utilization of similar services, our results may reflect, to a degree, the pattern of families seeking care in the ED. Increased use of the ED has previously been observed in the Medicaid population.…”

Section: Discussionmentioning

confidence: 88%

Hospital Admission and Emergency Department Utilization in an Infant Medicaid Population

Paul

Agiro

Hoffman

et al. 2016

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVE:In the first year of life, the rate of rehospitalization for infants has been shown to be between 4.4% and 9.5%. Reducing avoidable health care utilization is a population health priority. The goal of this study was to identify maternal and infant factors associated with rehospitalization and emergency department (ED) utilization in a cohort of newborn Medicaid recipients. METHODS:A longitudinal database was created by linking mother-infant dyads giving birth at a regional perinatal referral center with Delaware state Medicaid data. Multivariable logistic regression and negative binomial regression were used to examine inpatient hospitalization and ED utilization within 6 months after birth. RESULTS:The study cohort included 4112 infants; 452 (11.0%) were rehospitalized, and 1680 (41%) used the CONCLUSIONS:In this newborn Medicaid population, multiple maternal factors (including age, race, and mental health diagnoses) were associated with health care utilization in the 6 months after initial hospital discharge. Our data provide potential risk factors for targeted intervention and suggest that maternal factors should be considered in identifying a population at risk for rehospitalization and ED utilization.

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Section: Discussionmentioning

confidence: 88%

Hospital Admission and Emergency Department Utilization in an Infant Medicaid Population

Paul

Agiro

Hoffman

et al. 2016

Hospital Pediatrics

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“…The effect of early visit on readmission and mortality, although more pronounced in the first week (days [8][9][10][11][12][13][14][15], persisted during the entire follow-up period. Table 4 displays the results of prespecified subgroup analyses.…”

Section: Propensity-score-matched Cohortmentioning

confidence: 99%

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

et al. 2016

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Preventing readmission has been the focus of numerous quality improvement efforts across many conditions. Early outpatient follow-up has been proposed as the best mechanism for reducing readmissions. The extent to which early outpatient follow-up averts readmission or improves outcomes in cirrhosis is not known. We evaluated the relationship between early outpatient follow-up and short-term readmission and mortality in patients with cirrhosis. We conducted a retrospective cohort study of patients with cirrhosis who were hospitalized with a liver-related diagnosis and discharged to home from 122 Veterans Administration hospitals between 2010 and 2013. We defined early follow-up as an outpatient visit with a clinician within 7 days after discharge. We propensity matched patients who received early visit with those who did not have any visit and examined the associations between early follow-up and all-cause readmission and mortality within 8-30 days after discharge. Of 25,217 patients hospitalized with cirrhosis, 8,123 (32.2%) had an early follow-up visit within 7 days of discharge. A total of 3,492 (13.8%) patients were readmitted and 1,185 (4.6%) died between 8 and 30 days after discharge. In the propensity-matched sample (N 5 16,238), patients with early outpatient follow-up visit had a slightly higher risk of readmission (15.3% vs. 13.8%; hazard ratio [HR] 51.10; 95% confidence interval [CI] 5 1.02-1.19), but significantly lower risk of mortality (3.2% vs. 5.2%; HR 5 0.60; 95% CI 5 0.51-0.70) than those without early visit. The findings persisted in several subgroup and sensitivity analyses. Conclusions: Early outpatient follow-up after discharge was associated with a small increase in readmissions but lower overall mortality in patients with cirrhosis. Transitional care may be effective in improving short-term outcomes in patients with cirrhosis, but readmission performance measures would miss this effect. (HEPATOLOGY 2016;64:569-581) C irrhosis is a common and costly condition.Most patients with cirrhosis require frequent hospitalizations. Approximately 20% of patients with cirrhosis who have been hospitalized get readmitted to the hospital within the first 30 days after discharge, with substantial implications for outcomes and cost of care. (1)(2)(3) Hospital readmission is a problem that is not unique to patients with cirrhosis. (4-6) Readmission rates and consequently readmission reduction programs have been a major focus of recent quality improvement initiatives across many chronic conditions. In 2012, the Centers for Medicare and Medicaid Services (CMS) began to invoke penalties for readmissions of patients who have been discharged after hospitalizations for congestive heart failure (CHF), pneumonia, and acute myocardial infarction. (7) Recently, the CMS also started to reimburse for early transitional care as a

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“…44 Readmission rates are not solely an indicator of discharge quality; they are a measure of the entire health system, as well as socioeconomic factors and patient disease. 38,45,46 There is also no consensus on the optimal readmission interval. The Centers for Medicare and Medicaid Services uses 30 days for adult readmissions measures; however, some studies have used 7, 14, or 15 days.…”

Section: Figurementioning

confidence: 99%

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children

Tyler

Logsdon

et al. 2016

Pediatrics

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OBJECTIVE: To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. METHODS: This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children’s hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan–do–study–act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies. RESULTS: Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05). CONCLUSIONS: Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non–children’s hospital settings.

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Limits Of Readmission Rates In Measuring Hospital Quality Suggest The Need For Added Metrics

Cited by 64 publications

References 33 publications

Hospital Admission and Emergency Department Utilization in an Infant Medicaid Population

Hospital Admission and Emergency Department Utilization in an Infant Medicaid Population

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children

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