Impact of Post-Discharge Care Setting Following Inpatient Hospitalization on Hospital Revisits in a Medicare Population

Persistent Link:
http://hdl.handle.net/10150/301686
Title:
Impact of Post-Discharge Care Setting Following Inpatient Hospitalization on Hospital Revisits in a Medicare Population
Author:
Perera, K. Prasadini N.
Issue Date:
2013
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Background: In the current policy environment hospital readmissions are receiving considerable attention due to a provision in the Affordable Care Act (2010), that penalize hospitals through reduced payments for excess readmissions (the hospital readmissions reduction program (HRRP)). This program primarily holds hospitals accountable, although a multitude of factors not directly in control of hospitals can be contributory to readmissions. Of these, whether or not patients are discharged to an appropriate post-discharge care setting can be one contributory factor, and, this study evaluated the association between post-discharge care setting and hospital revisits. Methods: A retrospective analysis of the 2008 Medicare Current Beneficiary Survey (MCBS) was conducted. Three post-discharge care settings were evaluated: 1) routine discharge to home; 2) home with home healthcare; and 3) skilled nursing facility. Two outcomes were assessed: 1) 30-day all-cause hospital readmissions; and 2) 30-day all-cause hospital revisits (combination of inpatient admissions and emergency department visits). Analyses were carried out among patients with hospitalizations for any reason, as well as among a subgroup that were hospitalized for one of seven priority conditions identified in the HRRP. Weighted logistic regression analyses that incorporated information on the complex survey design were conducted. Results: Of the MCBS sample representing 46,048,125 Medicare beneficiaries (unweighted N=11,723), 4.9 percent (N= 2,293,629; unweighted N=670) contributed at least one index hospitalization to the analysis. Among hospitalization for any reason, 30-day all-cause hospital readmissions and revisits was 12.3 percent and 17.8 percent, respectively. The subgroup consisted of 31.8 percent of hospitalizations for any reason (N=730,174; unweighted N=216). Readmissions and revisits in the subgroup were 17.8 percent, and 24.5 percent, respectively. Post-discharge care setting was not significantly associated with either readmissions (P=0.966) or revisits (P=0.728) for hospitalizations for any reason. Findings for the subgroup were similar with no significant association between post-discharge care setting with either readmissions (P=0.850) or revisits (P=0.483). Conclusion: Absence of a difference in readmissions and revisits by post-discharge care setting suggests that the choice of discharge status might be appropriate following an inpatient admission. However, further research with larger sample sizes for conditions in the subgroup both together and separately is recommended.
Type:
text; Electronic Dissertation
Keywords:
post-acute care; Readmissions; Pharmaceutical Sciences; Medicare
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Graduate College; Pharmaceutical Sciences
Degree Grantor:
University of Arizona
Advisor:
Skrepnek, Grant H.

Full metadata record

DC FieldValue Language
dc.language.isoenen_US
dc.titleImpact of Post-Discharge Care Setting Following Inpatient Hospitalization on Hospital Revisits in a Medicare Populationen_US
dc.creatorPerera, K. Prasadini N.en_US
dc.contributor.authorPerera, K. Prasadini N.en_US
dc.date.issued2013-
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractBackground: In the current policy environment hospital readmissions are receiving considerable attention due to a provision in the Affordable Care Act (2010), that penalize hospitals through reduced payments for excess readmissions (the hospital readmissions reduction program (HRRP)). This program primarily holds hospitals accountable, although a multitude of factors not directly in control of hospitals can be contributory to readmissions. Of these, whether or not patients are discharged to an appropriate post-discharge care setting can be one contributory factor, and, this study evaluated the association between post-discharge care setting and hospital revisits. Methods: A retrospective analysis of the 2008 Medicare Current Beneficiary Survey (MCBS) was conducted. Three post-discharge care settings were evaluated: 1) routine discharge to home; 2) home with home healthcare; and 3) skilled nursing facility. Two outcomes were assessed: 1) 30-day all-cause hospital readmissions; and 2) 30-day all-cause hospital revisits (combination of inpatient admissions and emergency department visits). Analyses were carried out among patients with hospitalizations for any reason, as well as among a subgroup that were hospitalized for one of seven priority conditions identified in the HRRP. Weighted logistic regression analyses that incorporated information on the complex survey design were conducted. Results: Of the MCBS sample representing 46,048,125 Medicare beneficiaries (unweighted N=11,723), 4.9 percent (N= 2,293,629; unweighted N=670) contributed at least one index hospitalization to the analysis. Among hospitalization for any reason, 30-day all-cause hospital readmissions and revisits was 12.3 percent and 17.8 percent, respectively. The subgroup consisted of 31.8 percent of hospitalizations for any reason (N=730,174; unweighted N=216). Readmissions and revisits in the subgroup were 17.8 percent, and 24.5 percent, respectively. Post-discharge care setting was not significantly associated with either readmissions (P=0.966) or revisits (P=0.728) for hospitalizations for any reason. Findings for the subgroup were similar with no significant association between post-discharge care setting with either readmissions (P=0.850) or revisits (P=0.483). Conclusion: Absence of a difference in readmissions and revisits by post-discharge care setting suggests that the choice of discharge status might be appropriate following an inpatient admission. However, further research with larger sample sizes for conditions in the subgroup both together and separately is recommended.en_US
dc.typetexten_US
dc.typeElectronic Dissertationen_US
dc.subjectpost-acute careen_US
dc.subjectReadmissionsen_US
dc.subjectPharmaceutical Sciencesen_US
dc.subjectMedicareen_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplinePharmaceutical Sciencesen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorSkrepnek, Grant H.en_US
dc.contributor.committeememberSlack, Marion K.en_US
dc.contributor.committeememberArmstrong, Edward P.en_US
dc.contributor.committeememberRoe, Denise J.en_US
dc.contributor.committeememberAbraham, Ivoen_US
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