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Readmissions Revisited... Again

By William Martinez Moderator | 28 Jan, 2016

Recent article in Health Affairs attempts to account the factors that influence differences in readmission rates between safety net hospitals and other hospital. It uses a series of regression models to adjust for one factor at time that may affect readmissions. It concludes that while some of the difference is attributed to patient factors like poverty and lack of social supports, however some difference is still unexplained and likely represents differences in quality of care.

In their Incidental Economist post, researchers at Harvard School of Public Health point out methodological issues with the new study that may have affected the results.

The study comes on the heals of CMS new initiative to on Preventing Readmissions Among Racially and Ethnically Diverse Medicare Beneficiaries. The new CMS initiative acknowledges some of the problems with their hospital readmissions reduction program (HRRP) that penalizes hospitals with higher readmissions without adjusting for important social determinants.

CMS is suggesting hospitals develop interventions to prevent readmissions, especially in vulnerable, minority populations, through:
(a) creating systems responsive to the needs of diverse populations;
(b) ensuring patients have the social supports that they need to manage their condition; and
(c) addressing the social determinants that put them at continued and repetitive risk for readmission.

What do folks think? Is this realistic for hospitals to do? how?

Attached resources:

Replies

 

Elizabeth Glaser Replied at 9:29 AM, 28 Jan 2016

Did they account for for hospitals that brought patients in under
observation status vs admission? In my experience some facilities do
observation for almost any and all conditions but others are more judicious
in using observation. Those hospitals that use observation status as par
for the course may appear to have lower 30 day read mission rates . If they
adjusted for that then it would make for a more thorough analysis.

Jean Galiana Replied at 11:23 AM, 28 Jan 2016

Thank you for these wonderful resources William!

William Martinez Moderator Replied at 12:43 PM, 29 Jan 2016

Elizabeth-
That is a great point and something that has come up here before. I went back and looked and there is no mention of how much obs statuts may have affected readmission rates in the two groups (safety-net or other hospitals). It may be challenging to measure how much a hospital's use of obs status helped to lower their readmission rates. [Anyone familar with these data sets? Would adjusting for the use of Obs-status be possible?] If one group was using obs status more (safety-net or other hospitals) and it was impacting their readmission rates it would be important to account for this. The authors of the study do not flag this as a limitation, perhaps they should have. Previously others have pointed out that some of the improvements we have seen in readmission rates at some hospitals may have more to do with reclassication of patients to "observation" status and threfore not counting them as inpatients and readmissions (attached is a health affairs blog on this issue)

Attached resource:

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