Reducing Hospital Readmissions Among Medicaid Patients

Regenstein, Marsha; Andres, Ellie

doi:10.1097/qmh.0000000000000016

Cited by 19 publications

(16 citation statements)

References 42 publications

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“…In results of the first aim, the key point is that the population with chronic disease (either major chronic or system failure) had 16 times the rate of readmission compared to persons without major chronic disease. Our results support previous findings that low‐income individuals have unique care needs and therefore use the healthcare system differently than other populations (Regenstein & Andres, ). In 30‐, 60‐, and 90‐day periods, the rate of rehospitalization (including ED use) was approximately twice that of hospital readmission alone.…”

Section: Discussionsupporting

confidence: 91%

“…Both managed and accountable care patients had shorter lengths of stay and were more likely to have outpatient follow‐up visits in the first 30 days after discharge. Our results support previous findings that low‐income patients have higher rates of 30‐day readmission than do individuals with higher incomes (Regenstein & Andres, , Sommers & Cunningham, ; Trudnak et al, ) as do individuals with multiple chronic conditions in comparison to those with lower disease complexity (Elixhauser & Steiner, ; Steiner & Friedman, ).…”

Section: Discussionsupporting

confidence: 91%

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The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post‐Discharge Healthcare Utilization in a Low‐Income Population

Hewner

Casucci

Castner

2016

Research in Nursing & Health

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Economically disadvantaged individuals with chronic disease have high rates of in-patient (IP) readmission and emergency department (ED) utilization following initial hospitalization. The purpose of this study was to explore the relationships between chronic disease complexity, health system integration (admission to accountable care organization [ACO] hospital), availability of care management interventions (membership in managed care organization [MCO]), and 90-day post-discharge healthcare utilization. We used de-identified Medicaid claims data from two counties in western New York. The study population was 114,295 individuals who met inclusion criteria, of whom 7,179 had index hospital admissions in the first 9 months of 2013. Individuals were assigned to three disease complexity segments based on presence of 12 prevalent conditions. The 30-day inpatient (IP) readmission rates ranged from 6% in the non-chronic segment to 12% in the chronic disease complexity segment and 21% in the organ system failure complexity segment. Rehospitalization rates (both inpatient and emergency department [ED]) were lower for patients in MCOs and ACOs than for those in fee-for-service care. Complexity of chronic disease, initial hospitalization in a facility that was part of an ACO, MCO membership, female gender, and longer length of stay were associated with a significantly longer time to readmission in the first 90 days, that is, fewer readmissions. Our results add to evidence that high-value post-discharge utilization (fewer IP or ED rehospitalizations and early outpatient follow-up) require population-based transitional care strategies that improve continuity between settings and take into account the illness complexity of the Medicaid population. © 2016 Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post‐Discharge Healthcare Utilization in a Low‐Income Population

Hewner

Casucci

Castner

2016

Research in Nursing & Health

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“…Unplanned readmissions are a focus of healthcare quality measurement, as they may be preventable (3) and are associated with worse outcomes (4–5) and higher costs (6–7). Furthermore, repeated critical illness and hospitalization negatively impact patients and families (8–10).…”

Section: Introductionmentioning

confidence: 99%

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

Edwards

Lucas

Boscardin

et al. 2017

Critical Care Medicine

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Objectives To determine the incidence of unplanned readmissions to pediatric intensive care units (PICUs) within one year and examine risk factors associated with repeated readmission. Design, Settings, & Patients Retrospective cohort study of 93,379 patients discharged between 2009 and 2010 from 76 North American PICUs. Measurements Outcomes of index admissions and unplanned readmissions were compared. Timing of readmissions and variation of proportion of readmissions across sites were examined. Cumulative incidence curves for readmission were constructed. Time-to-event analyses were performed to examine factors associated with readmission within one year and to estimate their hazard ratios (HR). Main Results Eleven percent (10,233) of patients had 15,625 unplanned readmissions within one year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared to index admissions (4.0% versus 2.5%, and 2.5 versus 1.6 days, all P<0.001). Median time to readmission was 30 days for all readmissions; 3.5 days for readmissions during the same hospitalization; and 66 days for different hospitalizations. Time-to-event analyses showed that having more complex chronic conditions (CCCs) was associated with earlier readmission—adjusted HR 2.9 for one CCC; HR 4.8 for two CCC; HR 9.6 for three or more CCC, all P<0.001 compared no CCC). Most specific CCC conferred a greater risk of readmission, and some had considerably higher risk than others. Conclusions Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with CCCs and particular conditions were at much higher risk for readmission.

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“…We assess the effects of this intervention in two distinct patient populations-those over and under age 60-groups whose distinctive distribution of medical and psychiatric comorbidities [26][27][28] and different networks of social support 29,30 shape their post-discharge needs and potentially their response to the PN intervention.…”

Section: Introductionmentioning

confidence: 99%

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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Reducing Hospital Readmissions Among Medicaid Patients

Cited by 19 publications

References 42 publications

The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post‐Discharge Healthcare Utilization in a Low‐Income Population

The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post‐Discharge Healthcare Utilization in a Low‐Income Population

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

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

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