Proprietary management and higher readmission rates: A correlation

Mittal, Manish; Wang, Chih-Hsiung E.; Goben, Abigail; Boyd, Andrew D.

doi:10.1371/journal.pone.0204272

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…The studies included numbers of patients ranging from 122 to 524,892 for THA, from 84 to 952,593 for TKA, and from 1596 to 878,098 for THA and TKA combined. Four studies did not report the number of patients included (15,27,28,29). A wide range was found for the number of hospitals included for THA, TKA, and THA and TKA combined (i.e.…”

Section: Characteristicsmentioning

confidence: 99%

“…From the 13 studies reporting readmission rates, the between-hospital variation was reported in 5 studies (3 MQ, 2 LQ) for THA (9,21,30,35,36), 4 studies (3 MQ, 1 LQ) for TKA (21,33,35,37), and 6 studies (3 MQ, 3 LQ) for THA and TKA combined (15,16,28,38,39,40). Ten studies reported the variation for readmission more than once with different indicator definitions in all domains except for the type of patients selected (Table 4).…”

Section: Readmissionmentioning

confidence: 99%

“…mellitus (21), surgical time (21), work relative value unit (21), emergency surgery (21), patient comorbidities (16,28,38), Elixhauser comorbidities ( 9) procedure (THA/ TKA) (16), demographics (39), healthcare use (39), comorbidities selected by veteran affair surgical quality improvement programme (VASQIP) nurses (39), and clinical comorbidity (15). For complications, between-hospital variations were case-mix-adjusted for age (9,10,14,15,16,21,27,41,42,48,50), gender (9,10,14,15,21,27,41,42,48,50), ethnicity (21,41,42), Elixhauser comorbidities (9,41,48), patient comorbidities (14,16,27,38,42), ASA score (10,21), procedure (THA or TKA...…”

Section: :4 P Van Schie and Others 255mentioning

confidence: 99%

“…Between-hospital variation was generated mostly as feedback for quality improvement purposes (9,10,11,21,31,32,41,44,45,46), but also to assess variation by structural hospital characteristics (e.g. ownership structure or teaching status) (28,30,33,47,50,51,52), to assess outcome associations between specialisms and hospitals (39), and to assess the impact of coding schemes (42). Regardless of the purpose of the studies, 19 studies (58% of studies) informed individual hospitals about their performance (i.e.…”

Section: Context For Benchmarking Hospitalsmentioning

confidence: 99%

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International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports

et al. 2022

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In order to improve care for total hip and knee arthroplasties (THA/TKA), hospitals may want to compare their performance with hospitals in other countries. Pooling data across countries also enable early detection of infrequently occurring safety issues. We therefore aimed to assess the between-hospital variation and definitions used for revision, readmission, and complications across countries. PubMed, Embase, Web of Science, Cochrane library, Emcare, and Academic Search Premier were searched from January 2009 to August 2020 for studies reporting on: (i) primary THA/TKA; (ii) revision, readmission, or complications; and (iii) between-hospital variation. Most recent registry reports of Network of Orthopedic Registries of Europe members were also reviewed. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the Integrated quality Criteria for the Review Of Multiple Study designs tool for studies and relevant domains for registries. We assessed agreement for the following domains: (i) outcome definition; (ii) follow-up and starting point; (iii) case-mix adjustment; and (iv) type of patients and hospitals included. Between-hospital variation was reported in 33 (1 high-quality, 13 moderate-quality, and 19 low-quality) studies and 8 registry reports. The range of variation for revision was 0–33% for THA and 0–27% for TKA varying between assessment within hospital admission until 10 years of follow-up; for readmission, 0–40% and 0–32% for THA and TKA, respectively; and for complications, 0–75% and 0–50% for THA and TKA, respectively. Indicator definitions and methodological variables varied considerably across domains. The large heterogeneity in definitions and methods used likely explains the considerable variation in between-hospital variation reported for revision, readmission, and complications , making it impossible to benchmark hospitals across countries or pool data for earlier detection of safety issues. It is necessary to collaborate internationally and strive for more uniformity in indicator definitions and methods in order to achieve reliable international benchmarking in the future.

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Section: Characteristicsmentioning

confidence: 99%

Section: Readmissionmentioning

confidence: 99%

Section: :4 P Van Schie and Others 255mentioning

confidence: 99%

Section: Context For Benchmarking Hospitalsmentioning

confidence: 99%

See 2 more Smart Citations

International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports

et al. 2022

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“…All multivariable models controlled for important hospitallevel characteristics (see the Appendix for covariate details). These include hospital location 18 , geographic region 19 , hospital size (number of beds) 20 , medical school affiliation 20 , and ownership 21 . We also controlled for the volume of total hip and knee replacements that qualified for the measures 22 , the Disproportionate Patient Percentage 23 , and the transfer-adjusted case mix 24 , all of which were specified as continuous variables.…”

Section: Covariatesmentioning

confidence: 99%

Impact of Hospital Readmissions Reduction Program Penalties on Hip and Knee Replacement Readmissions

Thirukumaran

McGarry

Glance

et al. 2019

The Journal of Bone and Joint Surgery

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Background: Little is known about the impact of the U.S. Centers for Medicare & Medicaid Services' Hospital Readmissions Reduction Program (HRRP) expansion to include readmissions following elective primary total hip and knee replacements; the expansion was finalized in 2013 and was implemented in 2014. We examined whether hospitals at risk of relatively large penalties from this expansion experienced greater declines in joint replacement readmissions compared with hospitals at risk of smaller penalties. Methods: We used Medicare's 2009 to 2016 Hospital Compare data sets to examine the impact of the HRRP's expansion in the July 2013 to June 2016 period (post-expansion) compared with the July 2009 to June 2012 period (preexpansion). The primary outcome was the hospital-level, 30-day, risk-standardized readmission rate (hereafter called the readmission rate) following joint replacement surgical procedures. We used the percentage of a hospital's total inpatient revenue attributed to Medicare (categorized into quartiles) to represent the risk of penalties. We used hierarchical linear regression models to examine the adjusted impact of the HRRP's expansion. Results: Our study cohort included 2,326 acute care hospitals. In the pre-HRRP expansion phase, the mean readmission rate was 5.36% among hospitals with the highest proportion of Medicare revenues (quartile 4) and 5.46% among hospitals with the lowest proportion of Medicare revenues (quartile 1). With the HRRP expansion, the readmission rate declined by 18.92% (1.01 percentage points) among quartile-4 hospitals and by 17.97% (0.98 percentage point) among quartile-1 hospitals (p = 0.45). This nonsignificant difference in readmission rate declines between quartiles persisted in multivariable analysis (a decline of 18.41% [0.98 percentage point] in quartile 4 and a decline of 17.35% [0.94 percentage point] in quartile 1; p = 0.35). Conclusions: The HRRP's expansion to include joint replacements did not lead to greater reductions in postoperative readmissions among hospitals at risk of larger penalties in comparison with hospitals at risk of smaller penalties. Readmission rates were declining at similar rates among all hospitals, before and after the HRRP's expansion. Clinical Relevance: Readmissions and complications following joint replacements are measures of the quality of surgical care. These events have important clinical and economic implications for patients and providers. This study is clinically relevant because it examines whether policy interventions, such as the HRRP, have the potential to reduce these unintended consequences of surgical care. I n 2012, the U.S. Centers for Medicare & Medicaid Systems implemented the Hospital Readmissions Reduction Program (HRRP) to encourage hospitals to reduce read-missions for medical conditions. Under this initiative, hospitals with higher-than-expected readmission rates for Medicare feefor-service patients receive penalties as high as 3% of their base Disclosure: The efforts of Drs. Thirukumaran, Glance, Cai, and Li a...

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