Search

Background: Patients frequently experience suboptimal transitions from the hospital to the community, which can increase the likelihood of readmission. It is not known which care coordination services can lead to improvements in readmission rates.Objective: To evaluate the effects of two care coordination interventions on 30-day readmission rates.Design: Prospective multicenter observational study of hospitalized patients eligible for two care coordination services between January 1, 2013, and October 31, 2015. Readmission rates were compared for patients who received each care coordination intervention versus those who did not using multivariable generalized estimating equation logistic regression models.Participants: A total of 25,628 patients hospitalized in medicine, neurosciences, or surgical sciences units.Interventions: Patients discharged home and deemed to be at high risk for readmission were assigned a nurse Transition Guide (TG) for 30 days post-discharge. All other patients were assigned the Patient Access Line (PAL) intervention, which provided a post-discharge phone call from a registered nurse.Setting: Two large academic hospitals in Baltimore, MD.Main Measures: Thirty-day all-cause readmission to any Maryland hospital.Key Results: Among all patients, 14.2% (2409/16,993) of those referred for the PAL intervention and 22.8% (1973/8635) of those referred for the TG intervention were readmitted. PAL-referred patients who did not receive the intervention had an adjusted odds ratio (aOR) for readmission of 1.27 (95% confidence interval [95% CI] 1.12-1.44, p < 0.001) compared with patients who did. TG-referred patients who did not receive the TG intervention had an aOR of 1.83 (95% CI 1.60-2.10, p < 0.001) compared with patients who received the intervention. Younger age, male sex, having more comorbidities, and being discharged from a medicine unit were associated with not receiving an assigned intervention. These characteristics were also associated with higher readmission rates.Conclusions: PAL and TG care coordination interventions were associated with lower rates of 30-day readmission. Our findings underscore the importance of determining the appropriate intervention for the hardest-to-reach patients, who are also at the highest risk of being readmitted. [ABSTRACT FROM AUTHOR]

Background: Hospital performance on the 30-day hospital-wide readmission (HWR) metric as calculated by the Centers for Medicare and Medicaid Services (CMS) is currently reported as a quality measure. Focusing on patient-level factors may provide an incomplete picture of readmission risk at the hospital level to explain variations in hospital readmission rates.Objective: To evaluate and quantify hospital-level characteristics that track with hospital performance on the current HWR metric.Design: Retrospective cohort study.Setting/patients: A total of 4785 US hospitals.Metrics: We linked publically available data on individual hospitals published by CMS on patient-level adjusted 30-day HWR rates from July 1, 2011, through June 30, 2014, to the 2014 American Hospital Association annual survey. Primary outcome was performance in the worst CMS-calculated HWR quartile. Primary hospital-level exposure variables were defined as: size (total number of beds), safety net status (top quartile of disproportionate share), academic status [member of the Association of American Medical Colleges (AAMC)], National Cancer Institute Comprehensive Cancer Center (NCI-CCC) status, and hospital services offered (e.g., transplant, hospice, emergency department). Multilevel regression was used to evaluate the association between 30-day HWR and the hospital-level factors.Results: Hospital-level characteristics significantly associated with performing in the worst CMS-calculated HWR quartile included: safety net status [adjusted odds ratio (aOR) 1.99, 95% confidence interval (95% CI) 1.61-2.45, p < 0.001], large size (> 400 beds, aOR 1.42, 95% CI 1.07-1.90, p = 0.016), AAMC alone status (aOR 1.95, 95% CI 1.35-2.83, p < 0.001), and AAMC plus NCI-CCC status (aOR 5.16, 95% CI 2.58-10.31, p < 0.001). Hospitals with more critical care beds (aOR 1.26, 95% CI 1.02-1.56, p = 0.033), those with transplant services (aOR 2.80, 95% CI 1.48-5.31,p = 0.001), and those with emergency room services (aOR 3.37, 95% CI 1.12-10.15, p = 0.031) demonstrated significantly worse HWR performance. Hospice service (aOR 0.64, 95% CI 0.50-0.82, p < 0.001) and having a higher proportion of total discharges being surgical cases (aOR 0.62, 95% CI 0.50-0.76, p < 0.001) were associated with better performance.Limitation: The study approach was not intended to be an alternate readmission metric to compete with the existing CMS metric, which would require a re-examination of patient-level data combined with hospital-level data.Conclusion: A number of hospital-level characteristics (such as academic tertiary care center status) were significantly associated with worse performance on the CMS-calculated HWR metric, which may have important health policy implications. Until the reasons for readmission variability can be addressed, reporting the current HWR metric as an indicator of hospital quality should be reevaluated. [ABSTRACT FROM AUTHOR]