Lin WC, Kane RL, Finch MD, Potthoff SJ; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Wen-Chieh Lin, M.S. Ph.D. Candidate, Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Box 197 Mayo, 420 Delaware St. SE, Minneapolis, MN 55455. Tel: (612) 625-3629. Fax: (612) 624-8448. E-mail: linx0054@tc.umn.edu.
Research Objective: This study investigates the role of post-acute care (PAC) related to hospital readmission. Hospital readmission may indicate premature discharge and lack of appropriate resources at the PAC settings. It is still inconclusive whether PAC is a determinant of hospital readmission.Study Design: Data on 1993 Medicare short-term hospital discharges in 9 states (1 state from each census division) for 9 DRGs were obtained from the HCFA's MEDPAR file (338,747 cases). Hospital and market area factors are derived from the POS file, the AHA Annual Survey, and the ARF. The 9 DRGs accounted for a substantial amount of Medicare acute care hospitalization, including stroke, hip procedure, hip fracture, COPD, pneumonia, CHF, and diabetes. The dependent variable, hospital readmission within 30, 60 and 90 days after hospital discharge, is used in logit regressions for the initial analysis.Population Studied: Elderly Medicare beneficiaries.Principal Findings: Our findings show: (1) Patient characteristics are consistent predictors of hospital readmission. Patients with male gender, Medicaid status, more chronic conditions and any surgery or any ICU use in the initial hospitalization were more likely to be readmitted within 30 days after discharge. (2) Diagnosis and PAC modality are interacted. Patients with hip procedure were more likely to be readmitted with 30 days if they were discharged to skilled nursing facility (SNF) or inpatient rehabilitation unit (REH) compared to no PAC use. Patients with COPD, pneumonia, or CHF discharged to home health agency (HHA) after the initial hospitalization were more likely to be readmitted within 30 days. Patients with CHF were more likely to be readmitted within 30 days if they were discharged to REH or HHA; while they were less likely to be readmitted if they were discharged to SNF. (3) There were some variations in hospital readmission across states.Conclusions: Findings suggest that patient characteristics play a major role in the hospital readmission within 30 days after hospital discharge. PAC has impact on hospital readmission but varies across DRGs. Hospital characteristics have little influence on hospital readmission. States show some variation in hospital readmission rates. Since patients were not discharged into the PAC settings randomly, a two-stage selection-correction model will be used for final analysis to address selection bias. Hospital readmission within 60 and 90 days after hospital discharge will be analyzed.Implications for Policy: PAC is related to hospital readmission within 30 days after hospital discharge for patients with certain clinical conditions. Efficient PAC will vary by diagnosis. Adjusting for PAC may be able to provide more accuracy on profiling performance among hospitals. Such models are needed as a bases to plan any approach to address PPS for PAC overall as compared to the current individual PAC PPS models being developed.Primary Funding Source: Clinical Outcomes Research Center, University of Minnesota and Health Care Financing Administration.
Publication Types:
Keywords:
- Aftercare
- Aged
- Centers for Medicare and Medicaid Services (U.S.)
- Diagnosis-Related Groups
- Heart Failure
- Hip Fractures
- Hospitalization
- Humans
- Male
- Medicaid
- Medicare
- Minnesota
- Patient Discharge
- Patient Readmission
- Postnatal Care
- Skilled Nursing Facilities
- Subacute Care
- economics
- therapy
- hsrmtgs
Other ID:
UI: 102272453
From Meeting Abstracts