Reducing excess readmissions: promising effect of hospital readmissions reduction program in US hospitals

Lü, Ning; Huang, Kuo Cherh; Johnson, James A.

doi:10.1093/intqhc/mzv090

Cited by 47 publications

(33 citation statements)

References 20 publications

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“…Nearly all published studies have documented complications from inpatient treatment, inadequate quality of care or care coordination, and lack of patient follow-up and education as factors most closely related to hospital readmission after treatment for COPD 23,24. These same studies have implied that the single best strategy to reduce COPD and other disease specific readmissions is coordinated care 25–27.…”

Section: Discussionmentioning

confidence: 99%

Readmission After COPD Exacerbation Scale: determining 30-day readmission risk for COPD patients

Lau

Siracuse

Chamberlain

2017

COPD

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BackgroundCOPD affects over 13 million Americans, and accounts for over half a million hospitalizations annually. The Hospital Readmission Reduction Program, established by the Affordable Care Act requires the Centers for Medicare and Medicaid Services to reduce payments to hospitals with excess readmissions for COPD as of 2015. This study sought to develop a predictive readmission scale to identify COPD patients at higher readmission risk.MethodsDemographic and clinical data on 339,389 patients from New York and California (derivation cohort) and 258,113 patients from Washington and Florida (validation cohort) were abstracted from the State Inpatient Database (2006–2011), and the Readmission After COPD Exacerbation (RACE) Scale was developed to predict 30-day readmission risk.ResultsThirty-day COPD readmission rates were 7.54% for the derivation cohort and 6.70% for the validation cohort. Factors including age 40–65 years (odds ratio [OR] 1.17; 95% CI, 1.12–1.21), male gender (OR 1.16; 95% CI, 1.13–1.19), African American (OR 1.11; 95% CI, 1.06–1.16), 1st income quartile (OR 1.10; 95% CI, 1.06–1.15), 2nd income quartile (OR 1.06; 95% CI, 1.02–1.10), Medicaid insured (OR 1.83; 95% CI, 1.73–1.93), Medicare insured (OR 1.45; 95% CI, 1.38–1.52), anemia (OR 1.05; 95% CI, 1.02–1.09), congestive heart failure (OR 1.06; 95% CI, 1.02–1.09), depression (OR 1.18; 95% CI, 1.14–1.23), drug abuse (OR 1.17; 95% CI, 1.09–1.25), and psychoses (OR 1.19; 95% CI, 1.13–1.25) were independently associated with increased readmission rates, P<0.01. When the devised RACE scale was applied to both cohorts together, it explained 92.3% of readmission variability.ConclusionThe RACE Scale reliably predicts an individual patient’s 30-day COPD readmission risk based on specific factors present at initial admission. By identifying these patients at high risk of readmission with the RACE Scale, patient-specific readmission-reduction strategies can be implemented to improve patient care as well as reduce readmissions and health care expenditures.

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Section: Discussionmentioning

confidence: 99%

Readmission After COPD Exacerbation Scale: determining 30-day readmission risk for COPD patients

Lau

Siracuse

Chamberlain

2017

COPD

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“…To help mitigate the rising cost of healthcare and focus on quality improvement, Section 3025 of the Affordable Care Act established the Medicare Hospital Readmissions Reduction Program (HRRP). This program penalizes hospitals for unplanned readmissions within 30 days of discharge for specific medical conditions with decreased Medicare payments . In 2013, the first punitive penalties for 30‐day readmission began and rose from 1% of the hospital's base inpatient claims to 3% in 2015 .…”

Section: Introductionmentioning

confidence: 99%

Readmission following primary surgery for larynx and oropharynx cancer in the elderly

et al. 2016

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“…Despite efforts to optimize inpatient care delivery, 30-day readmissions are estimated to occur in 17 to 25% of patients hospitalized for pneumonia, at a cost of $10 billion (2)(3)(4)(5). Since the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Readmission Reduction Program in 2012, there has been an increased focus on pneumonia readmissions, because hospitals with higher-than-expected riskadjusted 30-day readmission rates face major financial penalties (6).…”

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confidence: 99%

Predicting the Risk of Readmission in Pneumonia. A Systematic Review of Model Performance

Weinreich¹,

Nguyen²,

Wang³

et al. 2016

Annals ATS

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Rationale: Predicting which patients are at highest risk for readmission after hospitalization for pneumonia could enable hospitals to proactively reallocate scarce resources to reduce 30-day readmissions.Objectives: To synthesize the available literature on readmission risk prediction models for adults who are hospitalized because of pneumonia and describe their performance. Methods:We systematically searched Ovid MEDLINE, Embase, The Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature databases from inception through July 2015. We included studies of adults discharged with pneumonia that developed or validated a model that predicted hospital readmission. Two independent reviewers abstracted data and assessed the risk of bias.Measurements and Main Results: Of 992 citations reviewed, 7 studies met inclusion criteria, which included 11 unique risk prediction models. All-cause 30-day readmission rates ranged from 11.8 to 20.8% (median, 17.3%). Model discrimination (C statistic) ranged from 0.59 to 0.77 (median, 0.63) with the highest-quality, best-validated model, the Centers for Medicare and Medicaid Services Pneumonia Administrative Model performing modestly (C Statistic of 0.63 in 4 separate multicenter cohorts). The best performing model (C statistic of 0.77) was a single-site study that lacked internal validation. The models had adequate calibration, with patients predicted as high risk for readmission having a higher average observed readmission rate than those predicted to be low risk. None of the studies included pneumonia illness severity scores, and only one included measures of in-hospital clinical trajectory and stability on discharge, robust predictors of readmission. Conclusions:We found a limited number of validated pneumoniaspecific readmission models, and their predictive ability was modest. To improve predictive accuracy, future models should include measures of pneumonia illness severity, hospital complications, and stability on discharge.

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Reducing excess readmissions: promising effect of hospital readmissions reduction program in US hospitals

Abstract: HRRP to reduce payments to hospitals with excess readmissions had a significant effect on the inpatient readmissions for PN, AMI and HF in US Hospitals.

Cited by 47 publications

References 20 publications

Readmission After COPD Exacerbation Scale: determining 30-day readmission risk for COPD patients

Readmission After COPD Exacerbation Scale: determining 30-day readmission risk for COPD patients

Readmission following primary surgery for larynx and oropharynx cancer in the elderly

Predicting the Risk of Readmission in Pneumonia. A Systematic Review of Model Performance

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