Pneumonia rehospitalization of the Medicare fee-for-service patient: a state-level analysis: exploring 30-day readmission factors

Evaluation of a Modified BOOST Tool in the Acute Care Setting: A Retrospective Analysis

Several readmission risk prediction tools exist but have had varying success in identifying patients at risk for readmission. The purpose of this project was to evaluate the effectiveness of a tool available within Project BOOST, Better Outcomes by Optimizing Safe Transitions, from the Society of Hospital Medicine. The tool was modified within the institution to include risk stratification scores in order to better identify the highest-risk patients. The modified risk tool may assist in predicting the risk of readmission in those patients with heart failure and chronic obstructive pulmonary disease who are discharged home.

Surgical rehospitalization of the medicare fee-for-service patient: a state-level analysis exploring 30-day readmission factors

PURPOSE OF STUDY

Surgical readmissions are a concern to the integrity of the Medicare Trust Fund and gaining attention from policymakers concerned about solvency. This study explores factors associated with variation in surgical readmission rates across the states and provides implications for Medicare Case Management.

PRIMARY PRACTICE SETTING(S)

Acute inpatient hospital settings.

METHODOLOGY AND SAMPLE

Fifty state-level data and multivariate regression analysis are used. The dependent variable Surgical Discharge 30-day Readmission Rate is based on the Medicare Fee-For-Service beneficiary population with Medicare Part A and B insurance coverage and age 65 years or older, rehospitalized subsequent to an inpatient surgical procedure, occurring within 30 days of their last discharge.

RESULTS

Our 2 key explanatory variables-emergency room visit rate and total days of care-are each positively associated with 30-day surgical readmission rate. Age group 65-69 years, native language, physician density, and health care expenditures per capita also influence surgical readmission rate across the states.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Surgical readmission has an association with many different categories of variables-demographic, clinical process, hospital capacity, and patient need. This strongly suggests that Medicare case managers consider the wide range of elements contributing to surgical readmission and take a multifactorial approach to reducing the rehospitalization rate.

Acute myocardial infarction rehospitalization of the medicare fee-for-service patient: a state-level analysis exploring 30-day readmission factors

PURPOSE OF THE STUDY

Acute myocardial infarction (AMI) readmission among the older adults is frequent and costly to the Medicare Trust Fund and to the patient in preventable suffering. In this study, we explore factors that are associated with states having AMI readmission rates that are higher than the U.S. national rate.

PRIMARY PRACTICE SETTING(S)

Acute inpatient hospital settings.

METHODOLOGY AND SAMPLE

Multivariate regression analysis of 50 state-level data is used. The dependent variable AMI 30-day readmission worse than U.S. rate is based on adult Medicare fee-for-service patients hospitalized with a primary discharge diagnosis of AMI and for which a subsequent all-cause readmission occurred within 30 days of their last discharge.

RESULTS

We find one key variable--states with more β-blocker prescription given at discharge--that is significantly associated with a decrease in probability in states ranking "worse" on AMI 30-day readmission. Whereas, states with more total days of care per 1,000 Medicare enrollees, more community hospital outpatient visits per 1,000 population, and greater aspirin prescription given at discharge have a greater probability for AMI 30-day readmission to be "worse" than the U.S. national rate.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Case management programs targeting efficient medication reconciliation from the hospital setting to the transfer setting can potentially help minimize readmission for patients highly dependent on β-blockers for improved clinical outcomes. This intervention may be more effective than other factors to improve state-level hospital status on AMI 30-day readmission. Factors such as total days of care per 1,000 Medicare enrollees, more community hospital outpatient visits per 1,000 populations, and greater aspirin prescription given at discharge may not be as important as β-blocker prescription given at discharge.

Readmission following pancreatectomy: what can be improved?

BACKGROUND

Readmissions after pancreatectomy, largely for the management of complications, may also occur as a result of failure to thrive or for diagnostic endeavours. Potential mechanisms to reduce readmission rates may be elucidated by assessing the adequacy of the initial disposition and the real necessity for readmission.

METHODS

Using previously identified categories of readmission following pancreatectomy, details of reasons for and results of readmissions were scrutinized using a root cause analysis approach.

RESULTS

Of 658 patients subjected to pancreatectomy between 2001 and 2010, 121 (18%) were readmitted within 30 days. The clinical course in 30% of readmitted patients was found to deviate from the pathway assumed on the initial admission. Patients were readmitted at a median of 9 days (range: 1-30 days) after initial discharge and had a median readmission length of stay of 7 days (mode = 4). Postoperative complications accounted for most readmissions (n = 77, 64%); 17 patients (14%) were readmitted for failure to thrive and 16 (13%) for diagnostics. Root cause analysis detailed subtextual reasons for readmission, including, for example, the initiation of new medications that could potentially have been ordered in an outpatient setting.

CONCLUSIONS

More than one quarter of readmissions after pancreatectomy occurred in the setting of failure to thrive or for diagnostic evaluation alone. Root cause analysis revealed potentially avoidable readmissions. The development of a system for stratifying patients at risk for readmission or the failure of the initial disposition, along with an alternative means of efficiently evaluating patients in an outpatient setting, could limit unnecessary readmissions and resource utilization.