Evaluating Whether Changes in Utilization of Hospital Outpatient Services Contributed to Lower Medicare Readmission Rate

Gerhardt, Geoffrey; Yemane, Alshadye; Apostle, Keri; Oelschlaeger, Allison; Rollins, E.; Brennan, Niall

doi:10.5600/mmrr.004.01.b03

Cited by 40 publications

(34 citation statements)

References 7 publications

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“…Readmission rates for LLC have not previously been described. In comparison, historical Medicare data showed an all-cause 30-day readmission rate of 18.5% in 2012 [8] .…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

et al. 2017

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Background: There is substantial allocation of resources directed towards evaluation and management of lower limb cellulitis (LLC) in the acute care setting. Readmission for LLC is poorly understood, and there is little evidence with which to identify patients at risk for readmission. Objective: To describe demographics, comorbidities, admission vital signs, and laboratory markers of infection among patients with LLC who are readmitted, and to investigate which among these factors is associated with readmission. Methods: A cross-sectional retrospective cohort study was performed at tertiary and community hospitals within a regional health care system in order to summarize readmission characteristics. Univariate and multivariate models were created to estimate the likelihood of independent variables being associated with LLC readmission. Results: The readmission rate was 11.2% with a median age of 68.6 years for the cohort. Increased age and subsidized insurance were associated with more frequent admissions. For every 10-year age increase, cellulitis subjects had a 14% increase in readmission odds (OR 1.14, CI 1.07-1.20). Patients with subsidized insurance had an almost twofold increased risk (OR 1.88, CI 1.42-2.50). Smoking, obesity, hypertension, diabetes mellitus, renal insufficiency, tachycardia, hypotension, leukocytosis, and neutrophilia were not more frequent in readmitted patients. Conclusions: Older age and subsidized insurance were associated with readmission whereas severity indicators for infection including abnormal vital signs and laboratory markers were not significantly associated. Factors other than severity of infection, such as socioeconomic factors, may influence clinical decisions related to readmission for LLC.

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“…Readmission rates for LLC have not previously been described. In comparison, historical Medicare data showed an all-cause 30-day readmission rate of 18.5% in 2012 [8] .…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

et al. 2017

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“…Hospital readmissions are common among older adults and are an international hospital quality indicator (Blunt et al, 2015; Gerhardt et al, 2014; Jencks et al, 2009; Parker, 2005). In the U.S., the Centers for Medicare and Medicaid Services (CMS) recently implemented the hospital readmission reduction program (Centers for Medicare and Medicaid Services, 2014) and funded implementation of care coordination interventions (Brock et al, 2013; Voss et al, 2011), based on evidence that readmissions can be prevented with proper transitional support and discharge planning (Coleman et al, 2006; Leppin et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge

Chavez

Liu

Tefft

et al. 2016

Drug and Alcohol Dependence

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Background Unhealthy alcohol use could impair recovery of older patients after medical or surgical hospitalizations. However, no prior research has evaluated whether older patients who screen positive for unhealthy alcohol use are at increased risk of readmissions or emergency department (ED) visits within 30 days after discharge. This study examined the association between AUDIT-C alcohol screening results and 30-day readmissions or ED visits. Methods Veterans Affairs (VA) patients age 65 years or older, were eligible if they were hospitalized for a medical or surgical condition (2/1/2009–10/1/2011) and had an AUDIT-C score documented in their VA electronic medical record in the year before they were hospitalized. VA and Medicare data identified VA or non-VA index hospitalizations, readmissions, and ED visits. Primary analyses adjusted for demographics, comorbid conditions, and past-year health care utilization. Results Among 579,330 hospitalized patients, 13.7% were readmitted and 12.0% visited an ED within 30 days of discharge. In primary analyses, high-risk drinking (n = 7167) and nondrinking (n =357,086) were associated with increased probability of readmission (13.8%, 95% CI 13.0–14.6%; and 14.2%, 95% CI 14.1–14.3%, respectively), relative to low-risk drinking (12.9%; 95% CI 12.7–13.0%). Only nondrinkers had increased risk for ED visits. Conclusions Alcohol screening results indicating high-risk drinking that were available in medical records were modestly associated with risk for 30-day readmissions and were not associated with risk for ED visits.

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“…1 While observation care was initially designed to provide an efficient alternative to inpatient hospitalization for patients with select diagnoses requiring a brief evaluation, such as chest pain or asthma, observation stays are now used for a wide variety of diagnoses. 2,3 Concurrent with broader use of observation stays, recent work has also demonstrated wide geographic and hospital-level variation in the use of observation stays.…”

Section: Introductionmentioning

confidence: 99%

Hospital Use of Observation Stays

et al. 2016

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Background The Centers for Medicare and Medicaid Services publicly reports hospital risk-standardized readmission rates (RSRRs) as a measure of quality and performance; mischaracterizations may occur because observation stays are not captured by current measures. Objectives To describe variation in hospital use of observation stays, the relationship between hospitals observation stay use and RSRRs. Methods Cross-sectional analysis of Medicare fee-for-service beneficiaries discharged after acute myocardial infarction (AMI), heart failure, or pneumonia between July 2011 and June 2012. We calculated three hospital-specific 30 day outcomes: 1) observation rate, the proportion of all discharges followed by an observation stay without a readmission; 2) observation proportion, the proportion of observation stays among all patients with an observation stay or readmission; and 3) RSRR. Results For all 3 conditions, hospitals’ observation rates were < 2.5% and observation proportions were < 12%, although there was variation across hospitals, including 28% of hospital with no observation stay use for AMI, 31% for heart failure, and 43% for pneumonia. There were statistically significant, but minimal, correlations between hospital observation rates and RSRRs: AMI (r=−0.02), heart failure (r=−0.11), and pneumonia (r=−0.02) (p<0.001). There were modest inverse correlations between hospital observation proportion and RSRR: AMI (r=−0.34), heart failure (r=−0.26), and pneumonia (r=−0.21) (p<0.001). If observation stays were included in readmission measures, <4% of top performing hospitals would be recategorized as having average performance. Conclusions Hospitals’ observation stay use in the post-discharge period is low, but varies widely. Despite modest correlation between the observation proportion and RSRR, counting observation stays in readmission measures would minimally impact public reporting of performance.

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Evaluating Whether Changes in Utilization of Hospital Outpatient Services Contributed to Lower Medicare Readmission Rate

Abstract: Objective: Descriptive analysis comparing changes in hospital inpatient readmissions to emergency department visits and observation stays that occurred within 30 days of an inpatient stay.

Cited by 40 publications

References 7 publications

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge

Hospital Use of Observation Stays

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