Dissertation/Thesis Abstract

The Relationship Between Medicare Readmission Rates and Hospital Modifiable Factors
by Ariely, Rinat, Ph.D., University of the Sciences in Philadelphia, 2018, 174; 10904827
Abstract (Summary)

Background: Hospital readmissions pose a substantial economic burden to the U.S. healthcare system. The 2010 Affordable Care Act’s Hospital Readmission Reduction Program (HRRP) penalties were instituted to incentivize hospitals to lower rates of readmission and costs, and to improve quality of care related to Medicare fee for service hospitalizations. Evidence about the impact that hospitals can have on their rates of readmission is limited, however.

Objectives: This study sought to quantify the proportion of 30-day readmissions for heart failure (HF), acute myocardial infarction (AMI), and pneumonia (PNE) that might be attributable to factors over which hospitals reasonably might be assumed to have control.

Methods: Calendar year 2014 data from the American Hospital Association, Medicare, and the Dartmouth Atlas of Healthcare, as well as year 2000 Area Deprivation Index scores were used to construct multivariable linear regression models. The proportion of groups of factors (hospital and patient), as well as individual factors, were tested for association with readmission rates.

Results: Most of the variability in readmission rates was unrelated to hospital specific-factors. Hospital factors were associated with 4-8% of readmission rate variance. Of these, non-modifiable factors were associated with 3-5% of readmission rate variance. Teaching status is associated with 0.30% higher readmission rate percentage points across readmission conditions. Follow-up primary care appointments are associated with 0.16% lower HF readmission rate percentage points, and every increase in staffing level unit was an associated with 0.19% lower PNE readmission rate percentage points. ACO affiliation was not associated with decreased readmission rates.

Conclusions: Hospital factors explained a very small portion of readmission rate variance. In addition, teaching status (a non-modifiable factor) was associated with higher readmission rates. Timely follow-up appointments in the community after discharge, and nurse staffing levels, were modifiable strategies associated with reduced readmissions. Further research should focus on collecting more comprehensive data on factors that impact readmission rates, especially safety net designation. Policies should consider incentivizing hospitals to offer programs, services, and adequate staffing to facilitate the patient transition from the hospital to the community, rather than penalizing hospitals for readmissions that may be largely out of the institution’s control.

Indexing (document details)
Advisor:
Commitee:
School: University of the Sciences in Philadelphia
School Location: United States -- Pennsylvania
Source: DAI-B 79/12(E), Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Public health, Health care management
Keywords: Accountable care organizations, Affordable care act, Inpatient, Medicare, Readmissions, Rehospitilizations
Publication Number: 10904827
ISBN: 978-0-438-15731-6
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