Reducing Hospital Readmissions Among Medicaid Patients

Regenstein, Marsha; Andres, Ellie

doi:10.1097/qmh.0000000000000043

Cited by 34 publications

(15 citation statements)

References 42 publications

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“…This trend and the percentage share were consistent with our results. Finally, a recent review of avoidable hospital use suggested that health services interventions should focus on individuals with mental illness and substance abuse, in agreement with our findings [ 30 ].…”

Section: Discussionsupporting

confidence: 90%

Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study

et al. 2016

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The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED) users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year) using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1%) were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p < 0.001 for each). Moreover, frequent ED users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED.

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Section: Discussionsupporting

confidence: 90%

Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study

et al. 2016

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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%

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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“…In addition, a study found that children who are rehospitalized for asthma might differ in disease severity, access to care, or environmental exposures when compared with those who were hospitalized only once [3]. However, asthma readmissions can be potentially prevented with appropriate and timely primary care given that asthma is regarded as one of the ambulatory care-sensitive conditions [4][5][6]. As such, reducing preventable hospital readmissions is a key priority in order to decrease health care costs and improve quality of care and patient experience [7].…”

Section: Introductionmentioning

confidence: 99%

Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study

Baek

Kash

et al. 2020

IJERPH

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Few studies have evaluated the association between ambient air pollution and hospital readmissions among children with asthma, especially in low-income communities. This study examined the short-term effects of ambient air pollutants on hospital readmissions for pediatric asthma in South Texas. A time-stratified case-crossover study was conducted using the hospitalization data from a children’s hospital and the air pollution data, including particulate matter 2.5 (PM2.5) and ozone concentrations, from the Centers for Disease Control and Prevention between 2010 and 2014. A conditional logistic regression analysis was performed to investigate the association between ambient air pollution and hospital readmissions, controlling for outdoor temperature. We identified 111 pediatric asthma patients readmitted to the hospital between 2010 and 2014. The single-pollutant models showed that PM2.5 concentration had a significant positive effect on risk for hospital readmissions (OR = 1.082, 95% CI = 1.008–1.162, p = 0.030). In the two-pollutant models, the increased risk of pediatric readmissions for asthma was significantly associated with both elevated ozone (OR = 1.023, 95% CI = 1.001–1.045, p = 0.042) and PM2.5 concentrations (OR = 1.080, 95% CI = 1.005–1.161, p = 0.036). The effects of ambient air pollutants on hospital readmissions varied by age and season. Our findings suggest that short-term (4 days) exposure to air pollutants might increase the risk of preventable hospital readmissions for pediatric asthma patients.

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Reducing Hospital Readmissions Among Medicaid Patients

Cited by 34 publications

References 42 publications

Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study

Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study

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

Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study

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