1
|
Lippert AM. System Failure: The Geographic Distribution of Sepsis-Associated Death in the USA and Factors Contributing to the Mortality Burden of Black Communities. J Racial Ethn Health Disparities 2023; 10:2397-2406. [PMID: 36171498 PMCID: PMC9518946 DOI: 10.1007/s40615-022-01418-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 12/03/2022]
Abstract
Sepsis is deadly and costly to health care systems, but these costs are disproportionately born by Black patients. Little empirical work has established the geographic patterning of sepsis or its area-level correlates. This study illustrates the geography of sepsis-associated death and racial composition of US counties with area socioeconomic indicators, health care access, and population health. Cartographic and spatially explicit analyses utilize mortality data from the National Cancer Institute and county data from the American Community Survey, Area Health Resource File, and County Health Rankings. Death rates are highest in the South, Southeast, and Appalachia. Counties disproportionately populated by Black people have higher death rates and associated risk indicators including poor air quality and vaccination coverage, socioeconomic distress, and impaired access to high-quality health care. Spatial Durbin error models suggest that conditions in nearby counties may also influence death rates within focal counties. Racial disparities in sepsis-associated death can be narrowed with improved health care equity-including immunization coverage-and by reducing socioeconomic distress in Black communities. Policy options for achieving these ends are discussed.
Collapse
Affiliation(s)
- Adam M Lippert
- Sociology Department, University of Colorado Denver, 1380 Lawrence Street. Suite 420, Denver, CO, 80204, USA.
| |
Collapse
|
2
|
Shin DY, Chang J, Ramamonjiarivelo ZH, Medina M. Does Geographic Location Affect the Quality of Care? The Difference in Readmission Rates Between the Border and Non-Border Hospitals in Texas. Risk Manag Healthc Policy 2022; 15:1011-1023. [PMID: 35585871 PMCID: PMC9109891 DOI: 10.2147/rmhp.s356827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Materials and Methods Results Conclusion
Collapse
Affiliation(s)
- Dong Yeong Shin
- Department of Public Health Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Jongwha Chang
- Department of Healthcare Administration, College of Business, Texas Woman’s University, Denton, TX, USA
- Correspondence: Jongwha Chang, Healthcare Administration, College of Business, Texas Woman’s University, 304 Administration Dr., Denton, TX, 76204, USA, Email
| | | | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA
| |
Collapse
|
3
|
Banerjee S, Paasche-Orlow MK, McCormick D, Lin MY, Hanchate AD. Readmissions performance and penalty experience of safety-net hospitals under Medicare's Hospital Readmissions Reduction Program. BMC Health Serv Res 2022; 22:338. [PMID: 35287693 PMCID: PMC8922916 DOI: 10.1186/s12913-022-07741-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Hospital Readmissions Reduction Program (HRRP), established by the Centers for Medicare and Medicaid Services (CMS) in March 2010, introduced payment-reduction penalties on acute care hospitals with higher-than-expected readmission rates for acute myocardial infarction (AMI), heart failure, and pneumonia. There is concern that hospitals serving large numbers of low-income and uninsured patients (safety-net hospitals) are at greater risk of higher readmissions and penalties, often due to factors that are likely outside the hospital's control. Using publicly reported data, we compared the readmissions performance and penalty experience among safety-net and non-safety-net hospitals. METHODS We used nationwide hospital level data for 2009-2016 from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare program, CMS Final Impact Rule, and the American Hospital Association Annual Survey. We identified as safety-net hospitals the top quartile of hospitals in terms of the proportion of patients receiving income-based public benefits. Using a quasi-experimental difference-in-differences approach based on the comparison of pre- vs. post-HRRP changes in (risk-adjusted) 30-day readmission rate in safety-net and non-safety-net hospitals, we estimated the change in readmissions rate associated with HRRP. We also compared the penalty frequency among safety-net and non-safety-net hospitals. RESULTS Our study cohort included 1915 hospitals, of which 479 were safety-net hospitals. At baseline (2009), safety-net hospitals had a slightly higher readmission rate compared to non-safety net hospitals for all three conditions: AMI, 20.3% vs. 19.8% (p value< 0.001); heart failure, 25.2% vs. 24.2% (p-value< 0.001); pneumonia, 18.7% vs. 18.1% (p-value< 0.001). Beginning in 2012, readmission rates declined similarly in both hospital groups for all three cohorts. Based on difference-in-differences analysis, HRRP was associated with similar change in the readmissions rate in safety-net and non-safety-net hospitals for AMI and heart failure. For the pneumonia cohort, we found a larger reduction (0.23%; p < 0.001) in safety-net hospitals. The frequency of readmissions penalty was higher among safety-net hospitals. The proportion of hospitals penalized during all four post-HRRP years was 72% among safety-net and 59% among non-safety-net hospitals. CONCLUSIONS Our results lend support to the concerns of disproportionately higher risk of performance-based penalty on safety-net hospitals.
Collapse
Affiliation(s)
- Souvik Banerjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA
| | - Danny McCormick
- Harvard Medical School, Boston, USA.,Division of Social and Community Medicine, Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
| | - Meng-Yun Lin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1063, USA
| | - Amresh D Hanchate
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1063, USA.
| |
Collapse
|
4
|
Taylor K, Davidson PM. Readmission to the hospital: common, complex and time for a re-think. J Clin Nurs 2021; 30:e56-e59. [PMID: 33394525 DOI: 10.1111/jocn.15631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022]
|
5
|
Aseltine RH, Wang W, Benthien RA, Katz M, Wagner C, Yan J, Lewis CG. Reductions in Race and Ethnic Disparities in Hospital Readmissions Following Total Joint Arthroplasty from 2005 to 2015. J Bone Joint Surg Am 2019; 101:2044-2050. [PMID: 31764367 DOI: 10.2106/jbjs.18.01112] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Racial and ethnic disparities in hospital readmissions following total joint arthroplasty present opportunities for reducing cost and improving health equity. Despite efforts to reduce readmissions following total joint arthroplasty in the general population, no studies have documented the impact of these efforts on racial and ethnic disparities in total joint arthroplasty readmissions. The purpose of this study was to determine whether comprehensive efforts to reduce hospital readmissions following total joint arthroplasty have impacted racial and ethnic disparities in readmission rates during the period from 2005 to 2015. METHODS We conducted a retrospective analysis comparing patients readmitted and not readmitted to the hospital within 30 days of a total joint arthroplasty by estimating logistic regression models for clustered data using generalized estimating equations (GEEs) in R. Connecticut hospital discharge data for patients admitted for International Classification of Diseases, Ninth Revision (ICD-9) procedure codes 81.51 and 81.54 (Current Procedural Terminology [CPT] codes 27130 and 27447) during the 2005 to 2015 U.S. Centers for Medicare & Medicaid Services (CMS) fiscal years were analyzed. Models included quadratic terms to capture nonlinear time trends in readmissions, as well as terms for the statistical interaction between race or ethnicity and both the linear and quadratic time trends in predicting the odds of readmission. RESULTS There were 102,510 total admissions to Connecticut hospitals for total joint arthroplasty from 2005 to 2015. The 30-day (all-cause) readmission rate declined from 5.1% in 2005 to 3.6% in 2015, with a steeper downward trend observed from 2009 to 2015. The results from logistic models indicated that black patients (odds ratio [OR], 1.68; p < 0.0001) and Hispanic patients (OR, 1.48; p < 0.0001) were significantly more likely to be readmitted within 30 days of discharge following a total joint arthroplasty than white patients over the study period. The significant interaction of black race and the quadratic time trend in models capturing nonlinear trends in readmission over time indicated that the readmission rates for black patients increased compared with those for white patients from 2005 through 2008 and decreased relative to those for white patients from 2009 to 2015 (OR, 0.24; p = 0.030). CONCLUSIONS Data from Connecticut hospitals show that 30-day readmissions following a total joint arthroplasty declined by 1.5 percentage points from 2005 to 2015, and that this decline was much more pronounced among black patients, resulting in the narrowing of racial disparities in readmission following a surgical procedure. CLINICAL RELEVANCE Racial and ethnic minorities have historically been at increased risk for complications and readmission following hospital-based surgical care. This analysis of readmission following total joint arthroplasty reveals that such disparities are remediable and should foster further research on the primary drivers of and remedies for readmission disparities.
Collapse
Affiliation(s)
- Robert H Aseltine
- Division of Behavioral Science and Community Health, UConn Health, Farmington, Connecticut
- Center for Population Health, UConn Health, Farmington, Connecticut
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Wenjie Wang
- Center for Population Health, UConn Health, Farmington, Connecticut
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Ross A Benthien
- Hartford Healthcare Bone & Joint Institute, Hartford, Connecticut
| | - Matthew Katz
- Connecticut State Medical Society, New Haven, Connecticut
| | | | - Jun Yan
- Center for Population Health, UConn Health, Farmington, Connecticut
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | | |
Collapse
|
6
|
Maman SR, Andreae MH, Gaber-Baylis LK, Turnbull ZA, White RS. Medicaid insurance status predicts postoperative mortality after total knee arthroplasty in state inpatient databases. J Comp Eff Res 2019; 8:1213-1228. [PMID: 31642330 DOI: 10.2217/cer-2019-0027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: Medicaid versus private primary insurance status may predict in-hospital mortality and morbidity after total knee arthroplasty (TKA). Materials & methods: Regression models were used to test our hypothesis in patients in the State Inpatient Database (SID) from five states who underwent primary TKA from January 2007 to December 2014. Results: Medicaid patients had greater odds of in-hospital mortality (odds ratio [OR]: 1.73; 95% CI: 1.01-2.95), greater odds of any postoperative complications (OR: 1.25; 95% CI: 1.18-1.33), experience longer lengths of stay (OR: 1.09; 95% CI: 1.08-1.10) and higher total charges (OR: 1.03; 95% CI: 1.02-1.04). Conclusion: Medicaid insurance status is associated with higher in-hospital mortality and morbidity in patients after TKA compared with private insurance.
Collapse
Affiliation(s)
- Stephan R Maman
- Penn State Milton S Hershey Medical Center, 500 University Drive, H187, Hershey, PA 17033, USA
| | - Michael H Andreae
- Penn State Milton S Hershey Medical Center, 500 University Drive, H187, Hershey, PA 17033, USA
| | - Licia K Gaber-Baylis
- Weill Cornell Medicine Center for Perioperative Outcomes, 428 East 72nd St., Ste 800A, New York, NY 10021, USA
| | - Zachary A Turnbull
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Robert S White
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| |
Collapse
|
7
|
Hamadi H, Moody L, Apatu E, Vossos H, Tafili A, Spaulding A. Impact of hospitals' Referral Region racial and ethnic diversity on 30-day readmission rates of older adults. J Community Hosp Intern Med Perspect 2019; 9:181-188. [PMID: 31258855 PMCID: PMC6586129 DOI: 10.1080/20009666.2019.1613882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/25/2019] [Indexed: 01/26/2023] Open
Abstract
Background: The Hospital Readmissions Reduction Program (HRRP) began decreasing Medicare payments to hospitals reporting high readmission rates for individuals over 65. Thus, financially incentivizing hospitals to improve quality performance on preventable readmissions. Well-established research indicates that minorities are more frequently readmitted to hospitals, but it is unknown if community diversity is associated with 30-day readmission rates. Objectives: To investigate the association between racial/ethnic diversity and hospitals' 30-day readmission rates. Methods: We linked the 2017 HRRP, American Hospital Association (AHA) database, Area Health Resource File, US Census Bureau Current Population Survey, and the Dartmouth Atlas HRR dataset to examine 30-day readmission rate for heart failure (HF), pneumonia (PN), acute myocardial infarction (AMI), and hip replacement (HR) surgery of 4,299 hospitals across 306 HRRs. Results: Our findings indicate a statistically significant negative relationship between diversity and 30-day readmission rates for HF, PN, AMI, and HR with a hospital referral region (HRR). Thus, hospitals located in HRRs with diverse populations are more likely to have higher 30-day readmission rates for all conditions under Medicare's HRRP Conclusion: Better discharge follow-up, interventions, and use of support staff aimed at meeting needs associated with differences in communities and cultures are likely to prove more fruitful than traditional one-size fits all approaches to care.
Collapse
Affiliation(s)
- Hanadi Hamadi
- Department of Health Administration, University of North Florida, Jacksonville, FL, USA
| | - Laree Moody
- Department of Health Administration, University of North Florida, Jacksonville, FL, USA
| | - Emma Apatu
- Department of Health Research Methods, McMaster University, Hamilton, Canada
| | - Helene Vossos
- School of Nursing, University of North Florida, Jacksonville, FL, USA
| | - Aurora Tafili
- Department of Health Administration, University of North Florida, Jacksonville, FL, USA
| | - Aaron Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
8
|
Kim JK, Garrett L, Latimer R, Nishizaki LK, Kimura JA, Taira D, Sentell T. Ke Ku'una Na'au: A Native Hawaiian Behavioral Health Initiative at The Queen's Medical Center. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2019; 78:83-89. [PMID: 31285976 PMCID: PMC6603896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although acute care facilities have not typically focused on resolving the psychosocial determinants of health, new models are emerging. This article provides details of the Ke Ku'una Na'au (KKN) Native Hawaiian Behavioral Health Initiative implemented in 2016 at The Queen's Medical Center in Honolulu, Hawai'i. The program is focused on reducing hospital readmissions for socially and economically vulnerable Native Hawaiian adults and improving their health care outcomes after hospitalization. The program was piloted on 2 medical units to assist patients who identified as Native Hawaiian, were ages 18 and older, and living with chronic diseases, psychosocial needs, and/or behavioral health problems. The program model was developed using a team of Native Hawaiian community health workers referred to as navigators, who were supported by an advanced practice nurse and a project coordinator/social worker. Navigators met patients during their inpatient stay and then followed patients post discharge to support them across any array of interpersonal needs for at least 30 days post-discharge. Goals were to assist patients with attending a post-hospital follow-up appointment, facilitate implementation of the discharge plan, and address social determinants of health that were impacting access to care. In 2017, 338 patients received care from the KKN program, a number that has grown since that time. In 2015, the baseline readmission rate for Native Hawaiians on the 2 medical units was 16.6% (for 440 Native Hawaiian patients in total). In 2017, the readmission rate for Native Hawaiians patients on the two medical units was 12.6% (for 445 Native Hawaiian patients, inclusive of KKN patients) (P=.092). This decrease suggests that the KKN program has been successful at reducing readmissions for vulnerable patients and, thus, improving care for Native Hawaiians in the health system generally. The KKN program has offered relevant, culturally sensitive care meeting a complex, personalized array of needs for over 338 patients and has shown demonstrated success in its outcomes. This information will be useful to other acute care organizations considering similar programs.
Collapse
Affiliation(s)
| | - Lisa Garrett
- The Queen's Medical Center, Honolulu, HI (LG, RL)
| | | | | | - Jo Ann Kimura
- The Queen's Health Systems, Honolulu, HI (JK, LKN, JAK)
| | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, Hilo, HI (DT)
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (TS)
| |
Collapse
|
9
|
Xue Y, Harel O, Aseltine RH. Imputing race and ethnic information in administrative health data. Health Serv Res 2019; 54:957-963. [PMID: 31099021 DOI: 10.1111/1475-6773.13171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To improve on existing methods to infer race/ethnicity in health care data through an analysis of birth records from Connecticut. DATA SOURCE A total of 162 467 Connecticut birth records from 2009 to 2013. STUDY DESIGN We developed a logistic model to predict race/ethnicity using data from US Census and patient-level information. Model performance was tested and compared to previous studies. Five performance measures were used for comparison. PRINCIPAL FINDINGS Our full model correctly classifies 81 percent of subjects and shows improvement over extant methods. We achieved substantially improved sensitivity in predicting black race. CONCLUSIONS Predictive models using Census information and patients' demographic characteristics can be used to accurately populate race/ethnicity information in health care databases, enhancing opportunities to investigate and address disparities in access to, utilization of, and outcomes of care.
Collapse
Affiliation(s)
- Yishu Xue
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Ofer Harel
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Robert H Aseltine
- Division of Behavioral Sciences and Community Health, UCONN Health, Farmington, Connecticut
| |
Collapse
|
10
|
Arroyo NS, White RS, Gaber-Baylis LK, La M, Fisher AD, Samaru M. Racial/Ethnic and Socioeconomic Disparities in Total Knee Arthroplasty 30- and 90-Day Readmissions: A Multi-Payer and Multistate Analysis, 2007–2014. Popul Health Manag 2019; 22:175-185. [DOI: 10.1089/pop.2018.0025] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Noelle S. Arroyo
- Department of Anesthesiology, Weill Cornell Medicine, Center for Perioperative Outcomes, New York, New York
| | - Robert S. White
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Licia K. Gaber-Baylis
- Department of Anesthesiology, Weill Cornell Medicine, Center for Perioperative Outcomes, New York, New York
| | - Melvin La
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Andrew D. Fisher
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Mahendranauth Samaru
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| |
Collapse
|
11
|
Socioeconomic, Racial, and Ethnic Disparities in Postpartum Readmissions in Patients with Preeclampsia: a Multi-state Analysis, 2007–2014. J Racial Ethn Health Disparities 2019; 6:806-820. [DOI: 10.1007/s40615-019-00580-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
|
12
|
Local Health Departments' Promotion of Mental Health Care and Reductions in 30-Day All-Cause Readmission Rates in Maryland. Med Care 2018; 56:153-161. [PMID: 29271821 DOI: 10.1097/mlr.0000000000000850] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Individuals affected with mental health conditions, including mood disorders and substance abuse, are at an increased risk of hospital readmission. OBJECTIVES The objective of this study is to examine whether local health departments' (LHDs) active roles of promoting mental health are associated with reductions in 30-day all-cause readmission rates, a common quality metric. METHODS Using datasets linked from multiple sources, including 2012-2013 State Inpatient Databases for the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Health Resource File, and US Census data, we employed multivariate logistic models to examine whether LHDs' active provision of mental health preventive care, mental health services, and health promotion were associated with the likelihood of having any 30-day all-cause readmission. RESULTS Multivariate logistic regressions showed that LHDs' provision of mental health preventive care, mental health services, and health promotion were negatively associated with the likelihoods of having any 30-day readmission for adults 18-64 years old (odds ratios=0.71-0.82, P<0.001), and adults 65 and above (odds ratios=0.61-0.63, P<0.001, preventive care and services, respectively). These estimated associations were more prominent among individuals with mental illness and/or substance use disorders, African Americans, Medicare, and Medicaid enrollees. CONCLUSIONS Our results suggest that LHDs in Maryland that engage in mental health prevention, promotion, and coordination activities are associated with benefits for residents and for the health care system at large. Additional research is needed to evaluate LHD activities in other states to determine if these results are generalizable.
Collapse
|
13
|
Gaskin DJ, Zare H, Vazin R, Love D, Steinwachs D. Racial and Ethnic Composition of Hospitals' Service Areas and the Likelihood of Being Penalized for Excess Readmissions by the Medicare Program. Med Care 2018; 56:934-943. [PMID: 30256281 PMCID: PMC6185808 DOI: 10.1097/mlr.0000000000000988] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Hospital Readmission Reduction Program (HRRP) disproportionately penalizes hospitals serving minority communities. The National Academy of Science, Engineering, and Medicine has recommended that the Centers for Medicare and Medicaid Services (CMS) consider adjusting for social risk factors in their risk adjustment methodology. This study examines the association between the racial and ethnic composition of a hospital market and the impact of other social risk factors on the probability of a hospital being penalized under the HRRP. RESEARCH METHODS AND DATA This study analyzes data from CMS, the American Hospital Association, and the American Community Survey for 3168 hospitals from 2013 to 2017. We used logistic regression models to estimate the association between the penalty status under HRRP and the racial and ethnic composition of a hospital market, and explored whether this association was moderated by other social risk factors. RESULTS Our results indicate that the probability of being penalized increases with the percentage of black and Asian residents in the hospital service area (HSA) and decreased with the percentage of Hispanic residents in the HSA. This association was reduced and became statistically insignificant when we controlled for other social risk factors. The strongest predictors of penalty status were the hospital's share of Medicaid patients and the percent of persons without a high school diploma in the HSA. CONCLUSIONS By incorporating relevant social risk factors in the reimbursement methodology, CMS could mitigate the negative effects of HRRP on hospitals serving minority communities.
Collapse
Affiliation(s)
- Darrell J Gaskin
- Johns Hopkins Bloomberg School of Public Health, William C. and Nancy F. Richardson Professor in Health Policy, Department of Health Policy and Management, Director of the Johns, Hopkins Center for Health Disparities Solutions, 624 North Broadway Ave, Hampton, House, Suite #441, Baltimore, Maryland, 21205, United States,
| | - Hossein Zare
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Johns Hopkins Center for Health Disparities Solutions, University of Maryland University College, Health Services Management, 624 North Broadway Ave, Hampton House, Room #310, Baltimore, Maryland, 21205, United States., Phone: +1 410-614-7246,
| | - Roza Vazin
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 North Broadway Ave, Hampton House, Room #307, Baltimore, Maryland, 21205, United States.,
| | | | - Donald Steinwachs
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 North Broadway Ave, Hampton House, Baltimore, Maryland, 21205, United States.,
| |
Collapse
|
14
|
Hamadi H, Apatu E, Loh CPA, Farah H, Walker K, Spaulding A. Does level of minority presence and hospital reimbursement policy influence hospital referral region health rankings in the United States. Int J Health Plann Manage 2018; 34:e354-e368. [PMID: 30207406 DOI: 10.1002/hpm.2654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
The shift from a fee-for-service payment to a value-based payment scheme, sparked by the Patient Protection and Affordable Care Act, introduced pay-for-performance programs such Hospital Value Based Purchasing. Previous inquiry has not considered how local community factors may affect hospital system performance. This study investigated the association between local health performance and minority population in a hospital referral region (HRR). The primary objective was to ascertain whether community diversity levels are significantly associated to local health performance guided by the ecological model. Secondary data analysis collected from the 2016 American Hospital Association, Area Health Resource File, Commonwealth Fund Scorecard on Local Health System Performance, and the Dartmouth Atlas HRR dataset was used. Our primary findings show that the more diverse a HRR is, the more likely it is to be associated with lower ranking for access and affordability prevention and treatment avoidable hospital use and cost as well as healthy lives. Total performance score was significantly related to a better health ranking on prevention and treatment, hospital use, and cost, as well as healthy lives. This research supports the assertion that communities, particularly minorities in those communities, affect local health care performance in a variety of ways.
Collapse
Affiliation(s)
- Hanadi Hamadi
- Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Chung-Ping Albert Loh
- Department of Economics and Geography, Coggin College of Business, University of North Florida, Jacksonville, FL, USA
| | - Hyett Farah
- Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Kirk Walker
- Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Aaron Spaulding
- Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, FL, USA
| |
Collapse
|
15
|
Abstract
This study examines whether the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excess readmissions for certain conditions, has reduced hospital readmissions and led to unintended consequences. Our analyses of Florida hospital administrative data between 2008 and 2014 find that the HRRP resulted in a reduction in the likelihood of readmissions by 1% to 2% for traditional Medicare (TM) beneficiaries with heart failure, pneumonia, or chronic obstructive pulmonary disease. Readmission rates for Medicare Advantage (MA) beneficiaries and privately insured patients with heart attack and heart failure decreased even more than TM patients with the same target condition (e.g., for heart attack, the likelihood for TM beneficiaries to be remitted is 2.2% higher than MA beneficiaries and 2.3% higher than privately insured patients). We do not find any evidence of cost-shifting, delayed readmission, or selection on discharge disposition or patient income. However, the HRRP reduced the likelihood of Hispanic patients with target conditions being admitted by 2% to 4%.
Collapse
|
16
|
Increasing Research Capacity in a Safety Net Setting Through an Academic Clinical Partnership. ACTA ACUST UNITED AC 2017; 47:350-355. [DOI: 10.1097/nna.0000000000000491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Alrawashdeh M, Zomak R, Dew MA, Sereika S, Song MK, Pilewski J, DeVito Dabbs A. Pattern and Predictors of Hospital Readmission During the First Year After Lung Transplantation. Am J Transplant 2017; 17:1325-1333. [PMID: 27676226 PMCID: PMC5368039 DOI: 10.1111/ajt.14064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/11/2016] [Accepted: 09/18/2016] [Indexed: 01/25/2023]
Abstract
Hospital readmission after lung transplantation negatively affects quality of life and resource utilization. A secondary analysis of data collected prospectively was conducted to identify the pattern of (incidence, count, cumulative duration), reasons for and predictors of readmission for 201 lung transplant recipients (LTRs) assessed at 2, 6, and 12 mo after discharge. The majority of LTRs (83.6%) were readmitted, and 64.2% had multiple readmissions. The median cumulative readmission duration was 19 days. The main reasons for readmission were other than infection or rejection (55.5%), infection only (25.4%), rejection only (9.9%), and infection and rejection (0.7%). LTRs who required reintubation (odds ratio [OR] 1.92; p = 0.008) or were discharged to care facilities (OR 2.78; p = 0.008) were at higher risk for readmission, with a 95.7% cumulative incidence of readmission at 12 mo. Thirty-day readmission (40.8%) was not significantly predicted by baseline characteristics. Predictors of higher readmission count were lower capacity to engage in self-care (incidence rate ratio [IRR] 0.99; p = 0.03) and discharge to care facilities (IRR 1.45; p = 0.01). Predictors of longer cumulative readmission duration were older age (arithmetic mean ratio [AMR] 1.02; p = 0.009), return to the intensive care unit (AMR 2.00; p = 0.01) and lower capacity to engage in self-care (AMR 0.99; p = 0.03). Identifying LTRs at risk may assist in optimizing predischarge care, discharge planning and long-term follow-up.
Collapse
Affiliation(s)
| | - Rachelle Zomak
- Cardiothoracic Transplantation Program, UPMC, Pittsburgh, PA
| | - Mary Amanda Dew
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Susan Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Mi-Kyung Song
- School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Joseph Pilewski
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | |
Collapse
|
18
|
Daar DA, Alvarez-Estrada M, Alpert AE. The Latino Physician Shortage: How the Affordable Care Act Increases the Value of Latino Spanish-Speaking Physicians and What Efforts Can Increase Their Supply. J Racial Ethn Health Disparities 2017; 5:170-178. [PMID: 28364372 DOI: 10.1007/s40615-017-0354-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/01/2017] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
The United States Latino population is growing at a rapid pace and is set to reach nearly 30% by 2050. The demand for culturally and linguistically competent health care is increasing in lockstep with this growth; however, the supply of doctors with skills and experience suited for this care is lagging. In particular, there is a major shortage of Latino Spanish-speaking physicians, and the gap between demand and supply is widening. The implementation of the Affordable Care Act (ACA) has increased the capacity of the US healthcare system to care for the growing Latino Spanish-speaking population, through health insurance exchanges, increased funding for safety net institutions, and efforts to improve efficiency and coordination of care, particularly with Accountable Care Organizations and the Hospital Readmissions Reduction Program. With these policies in mind, the authors discuss how the value of Latino Spanish-speaking physicians to the healthcare system has increased under the environment of the ACA. In addition, the authors highlight key efforts to increase the supply of this physician population, including the implementation of the Deferred Action for Childhood Arrivals Act, premedical pipeline programs, and academic medicine and medical school education initiatives to increase Latino representation among physicians.
Collapse
Affiliation(s)
- David A Daar
- University of California Irvine School of Medicine, Irvine, CA, USA.,The UC Irvine Paul Merage School of Business, Irvine, CA, USA
| | - Miguel Alvarez-Estrada
- University of California Irvine School of Medicine, Irvine, CA, USA. .,The UC Irvine Paul Merage School of Business, Irvine, CA, USA.
| | | |
Collapse
|
19
|
Trudnak T, Kelley D, Zerzan J, Griffith K, Jiang HJ, Fairbrother GL. Medicaid admissions and readmissions: understanding the prevalence, payment, and most common diagnoses. Health Aff (Millwood) 2016; 33:1337-44. [PMID: 25092834 DOI: 10.1377/hlthaff.2013.0632] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Reducing hospital readmissions is a way to improve care and reduce avoidable costs. However, there have been few studies of readmissions in the Medicaid population. We sought to characterize acute care hospital admissions and thirty-day readmissions in the Medicaid population through a retrospective analysis in nineteen states. We found that Medicaid readmissions were both prevalent (9.4 percent of all admissions) and costly ($77 million per state) and that they represented 12.5 percent of Medicaid payments for all hospitalizations. Five diagnostic groups appeared to drive Medicaid readmissions, accounting for 57 percent of readmissions and 49 percent of hospital payments for readmissions. The most prevalent diagnostic categories were mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications, which together accounted for 31.2 percent of readmissions. This analysis, conducted through the Medicaid Medical Directors Learning Network, allows Medicaid medical directors to better understand the nature and prevalence of hospital use in the Medicaid population and provides a baseline for measuring improvement.
Collapse
Affiliation(s)
- Tara Trudnak
- Tara Trudnak was a senior research manager at AcademyHealth at the time of this study and is currently a senior researcher at the Altarum Institute, in Alexandria, Virginia
| | - David Kelley
- David Kelley is chief medical officer of the Pennsylvania Department of Public Welfare, in Harrisburg
| | - Judy Zerzan
- Judy Zerzan is chief medical officer and director of the Client and Clinical Care Office, Colorado Department of Health Care Policy and Financing, in Denver
| | - Katherine Griffith
- Katherine Griffith is a senior manager at AcademyHealth, in Washington, D.C
| | - H Joanna Jiang
- H. Joanna Jiang is a senior social scientist in the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, in Rockville, Maryland
| | | |
Collapse
|
20
|
Brooks-Carthon JM, Lasater KB, Rearden J, Holland S, Sloane DM. Unmet Nursing Care Linked to Rehospitalizations Among Older Black AMI Patients: A Cross-Sectional Study of US Hospitals. Med Care 2016; 54:457-65. [PMID: 27075902 PMCID: PMC4834898 DOI: 10.1097/mlr.0000000000000519] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies suggest that nurses may be unable to complete all aspects of necessary care due to a lack of time. Research is needed to determine whether unmet nursing care contributes to disparities in readmissions for vulnerable populations. OBJECTIVES To examine differences in the relationship between nursing care left undone and acute myocardial infarction readmissions among older black patients compared with older white patients. RESEARCH DESIGN Cross-sectional analysis of multiple datasets, including: 2006 to 2007 administrative discharge data, a survey of registered nurses, and the American Hospital Association Annual Survey. Risk-adjusted logistic regression models were used to estimate the association between care left undone and 30-day readmission. Interactions were used to examine the moderating effect of care left undone on readmission by race. RESULTS The sample included 69,065 patients in 253 hospitals in California, New Jersey, and Pennsylvania. Older black patients were 18% more likely to experience a readmission after adjusting for patient and hospital characteristics and more likely to be in hospitals where nursing care was often left undone. Black patients were more likely to be readmitted when nurses were unable to talk/comfort patients [odds ratio (OR), 1.09; 95% confidence interval (CI), 1.01-1.19], complete documentation (OR, 1.16; 95% CI, 1.01-1.32), or administer medications in a timely manner (OR, 1.26; 95% CI, 1.09-1.46). CONCLUSIONS Unmet nursing care is associated with readmissions for older black patients following acute myocardial infarction. Investment in nursing resources to improve the delivery of nursing care may decrease disparities in readmission.
Collapse
Affiliation(s)
- J. Margo Brooks-Carthon
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104 USA
| | - Karen B. Lasater
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104 USA
| | - Jessica Rearden
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104 USA
| | - Sara Holland
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104 USA
| | - Douglas M. Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104 USA
| |
Collapse
|
21
|
O'Connor M, Murtaugh CM, Shah S, Barrón-Vaya Y, Bowles KH, Peng TR, Zhu CW, Feldman PH. Patient Characteristics Predicting Readmission Among Individuals Hospitalized for Heart Failure. Med Care Res Rev 2016; 73:3-40. [PMID: 26180045 PMCID: PMC4712072 DOI: 10.1177/1077558715595156] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/12/2015] [Indexed: 11/17/2022]
Abstract
Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variation in hospital readmission rates. Database searches yielded 950 potential articles, of which 34 studies met inclusion criteria. Patient characteristics generally have a very modest effect on all-cause or heart failure-related readmission within 7 to 180 days of index hospital discharge. A range of cardiac diseases and other comorbidities only minimally increase readmission rates. No single patient characteristic stands out as a key contributor across multiple studies underscoring the challenge of developing successful interventions to reduce readmissions. Interventions may need to be general in design with the specific intervention depending on each patient's unique clinical profile.
Collapse
Affiliation(s)
| | | | - Shivani Shah
- Visiting Nurse Service of New York, New York, NY, USA
| | | | - Kathryn H Bowles
- Visiting Nurse Service of New York, New York, NY, USA University of Pennsylvania, Philadelphia, PA, USA
| | | | - Carolyn W Zhu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | |
Collapse
|
22
|
Abstract
BACKGROUND Policymakers have expanded readmissions penalties to include elective total hip arthroplasties (THA), but little is known whether disparities exist on the basis of race, socioeconomic status, or payer. OBJECTIVE To identify disparities in elective primary THA readmissions based on race, socioeconomic status, and type of insurance. RESEARCH DESIGN This analysis is a retrospective cohort study of patients discharged for an elective THA. The Healthcare Cost & Utilization Project's State Inpatient Database from California was used to identify index hospitalizations for elective primary THA and rehospitalizations within 30 days of discharge. We used multivariate logistic regression to examine differences in readmissions by race, socioeconomic status, and insurance. SUBJECTS Subjects included patients discharged from California hospitals from 2009 through 2011 after THA. MEASURES Risk-adjusted odds of all-cause 30-day readmission. RESULTS The overall rate of unplanned 30-day all-cause readmissions was 4.6%. African American [odds ratio (OR)=1.38; 95% confidence interval (CI), 1.16-1.64] and Hispanic (OR=1.16; 95% CI, 1.00-1.34) patients had a higher risk of readmission than white patients after THA, when accounting for comorbidities and hospital factors. The observed difference for Hispanic patients, however, was null after adjusting for socioeconomic status and payer. Lower socioeconomic status was associated with higher odds of readmission (OR=1.24; 95% CI, 1.10-1.39). Compared with private insurance, Medicare (OR=1.26; 95% CI, 1.13-1.43), Medicaid (OR=1.86; 95% CI, 1.49-2.32), and uninsured status (OR=1.31; 95% CI, 1.01-1.69) were also associated with increased readmission risk. CONCLUSIONS We found significant differences in the odds of 30-day readmissions on the basis of race, socioeconomic status, and payer. As readmissions penalties become widely adopted, payers need to be mindful of their effects on vulnerable populations.
Collapse
|
23
|
Jorgenson ES, Richardson DM, Thomasson AM, Nelson CL, Ibrahim SA. Race, Rehabilitation, and 30-Day Readmission After Elective Total Knee Arthroplasty. Geriatr Orthop Surg Rehabil 2015; 6:303-10. [PMID: 26623166 PMCID: PMC4647199 DOI: 10.1177/2151458515606781] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: To examine racial variations in access to postacute care (PAC) and rehabilitation (Rehab) services following elective total knee arthroplasty and whether where patients go after surgery for PAC/Rehab is associated with 30-day readmission to acute care facility. Materials and Methods: Sample consisted of 129 522 patients discharged from 169 hospitals in the State of Pennsylvania between fiscal years 2008 and 2012. We used multinomial regression models to assess the relationship between patient race and discharge destination after surgery, for patients aged 18 to 64 years and for those aged 65 and older. We used multivariable (MV) regression and propensity score (PS) approaches to examine the relationship between patient discharge destination after surgery for PAC/Rehab and 30-day readmission, controlling for key individual- and facility-level factors. Results: Lower proportions of younger patients compared to those older than 65 were discharged to inpatient rehabilitation facilities (IRFs; 5.8% vs 12.6%, respectively) and skilled nursing facilities (SNFs; 15.2% vs 32.7%, respectively) compared to home-based Rehab (self-care; 23.3% vs 14.2%, respectively). Compared to whites, African American patients had significantly higher odds of discharge to IRF (age < 65, odds ratio = 2.04; age ≥ 65, odds ratio = 1.64) and to SNF (age < 65, odds ratio = 2.86; age ≥ 65, odds ratio = 2.19) and discharge to home care in patients younger than 65 years (odds ratio = 1.31). The odds of 30-day readmission among patients discharged to an IRF (MV odds ratio = 7.76; PS odds ratio = 8.34) and SNF (MV odds ratio = 2.01; PS odds ratio = 1.83) were significantly higher in comparison to patients discharged home with self-care. Conclusion: African American patients with knee replacement are more likely to be discharged to inpatient Rehab settings following surgery. Inpatient Rehab is significantly associated with 30-day readmission to acute care facility.
Collapse
Affiliation(s)
- Erik S Jorgenson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Diane M Richardson
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Arwin M Thomasson
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Charles L Nelson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA ; Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Said A Ibrahim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA ; Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA
| |
Collapse
|
24
|
|
25
|
Evaluating diabetes health policies using natural experiments: the natural experiments for translation in diabetes study. Am J Prev Med 2015; 48:747-54. [PMID: 25998925 PMCID: PMC5210173 DOI: 10.1016/j.amepre.2014.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/03/2014] [Accepted: 12/15/2014] [Indexed: 11/21/2022]
Abstract
The high prevalence and costs of type 2 diabetes makes it a rapidly evolving focus of policy action. Health systems, employers, community organizations, and public agencies have increasingly looked to translate the benefits of promising research interventions into innovative policies intended to prevent or control diabetes. Though guided by research, these health policies provide no guarantee of effectiveness and may have opportunity costs or unintended consequences. Natural experiments use pragmatic and available data sources to compare specific policies to other policy alternatives or predictions of what would likely have happened in the absence of any intervention. The Natural Experiments for Translation in Diabetes (NEXT-D) Study is a network of academic, community, industry, and policy partners, collaborating to advance the methods and practice of natural experimental research, with a shared aim of identifying and prioritizing the best policies to prevent and control diabetes. This manuscript describes the NEXT-D Study group's multi-sector natural experiments in areas of diabetes prevention or control as case examples to illustrate the selection, design, analysis, and challenges inherent to natural experimental study approaches to inform development or evaluation of health policies.
Collapse
|
26
|
Sentell TL, Ahn HJ, Miyamura J, Juarez DT. Cost Burden of Potentially Preventable Hospitalizations for Cardiovascular Disease and Diabetes for Asian Americans, Pacific Islanders, and Whites in Hawai'i. J Health Care Poor Underserved 2015; 26:63-82. [PMID: 25981089 PMCID: PMC4554682 DOI: 10.1353/hpu.2015.0068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We compared the cost burdens of potentially preventable hospitalizations for cardiovascular disease and diabetes for Asian Americans, Pacific Islanders, and Whites using Hawai'i statewide 2007-2012 inpatient data. The cost burden of the 27,894 preventable hospitalizations over six years (total cost: over $353 million) fell heavily on Native Hawaiians who had the largest proportion (23%) of all preventable hospitalizations and the highest unadjusted average costs (median: $9,117) for these hospitalizations. Diabetes-related amputations (median cost: $20,167) were the most expensive of the seven preventable hospitalization types. After adjusting for other factors (including age, insurance, and hospital), costs for preventable diabetes-related amputations were significantly higher for Native Hawaiians (ratio estimate:1.23; 95%CI:1.05-1.44), Japanese (ratio estimate:1.44; 95%CI:1.20-1.72), and other Pacific Islanders (ratio estimate:1.26; 95%CI:1.04-1.52) compared with Whites. Reducing potentially preventable hospitalizations would not only improve health equity, but could also relieve a large and disproportionate cost burden on some Pacific Islander and Asian American communities.
Collapse
|
27
|
Martinez J, Leland N. Language Discordance and Patient- Centered Care in Occupational Therapy: A Case Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2015; 35:120-8. [PMID: 26460475 PMCID: PMC5365343 DOI: 10.1177/1539449215575265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The accumulative burden of a growing non-English speaking minority population and health disparities in the United States demonstrate the urgency of examining occupational therapy practices and defining care that is timely, effective, safe, and patient-centered. In this context, we investigate an occupational therapy episode of care from the perspectives of patient, caregiver, and primary occupational therapy care provider. Treatment sessions were observed and one-on-one semistructured interviews were conducted with the participants. Several themes describing areas of concern in communication and care delivery emerged, including expectations for care, the therapy relationship, professional identity, and pragmatic constraints. The use of untrained interpreters compromised treatment effectiveness and safety. This case highlights potential areas of concern in therapy when working with a diverse patient population. Abundant opportunities exist for occupational therapy to situate itself as an equitable, responsive, valuable, and essential service.
Collapse
|
28
|
Damiani G, Salvatori E, Silvestrini G, Ivanova I, Bojovic L, Iodice L, Ricciardi W. Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review. Clin Interv Aging 2015; 10:237-45. [PMID: 25653510 PMCID: PMC4310718 DOI: 10.2147/cia.s71165] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF) and acute myocardial infarction (AMI) are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI. METHODS The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen's Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies. RESULTS A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6%) were found for the short-term outcome, and four studies (36.4%) were found for the long-term outcome. For the short-term outcome, race/ethnicity and marital status showed a positive cumulative effect on the risk for readmission. Regarding the educational level of a patient, no effect was found. CONCLUSION Among the socioeconomic factors, mainly race/ethnicity and marital status affect the risk for readmission in elderly people with HF or AMI. Multidisciplinary hospital-based quality initiatives, disease management, and care transition programs are a priority for health care systems to achieve better coordination.
Collapse
Affiliation(s)
- Gianfranco Damiani
- Department of Public Health, Università Cattolica Sacro Cuore, Rome, Italy
| | - Eleonora Salvatori
- Department of Public Health, Università Cattolica Sacro Cuore, Rome, Italy
| | - Giulia Silvestrini
- Department of Public Health, Università Cattolica Sacro Cuore, Rome, Italy
| | - Ivana Ivanova
- ERAWEB Project, Faculty of Medicine, Saints Cyril and Methodius University of Skopje, Skopje, Macedonia; Serbia
| | - Luka Bojovic
- ERAWEB Project, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Lanfranco Iodice
- Department of Public Health, Università Cattolica Sacro Cuore, Rome, Italy
| | - Walter Ricciardi
- Department of Public Health, Università Cattolica Sacro Cuore, Rome, Italy
| |
Collapse
|
29
|
Clendennen SL, Bowden RG, Griggs JO, Morgan GB, Umstattd Meyer MR. Risk factors associated with the timing of hospital readmission in an underserved low socioeconomic population. Hosp Pract (1995) 2015; 43:284-289. [PMID: 26560327 DOI: 10.1080/21548331.2015.1119024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Compare risk factors of hospital readmission between 30-, 60- and 90-day readmission groups in a low socioeconomic population. METHODS Secondary data obtained from the Epic Systems database management system for patients who experienced a 30-, 60- or 90-day hospital readmission between 2006 and 2013. Risk factors analyzed included sex, race/ethnicity, follow-up status, age, BMI, systolic blood pressure, body temperature and pulse rate. Records for 2191 low-income patients (µ age = 44.5 years; 72.5% female; 10.1% African American, 26.2% Hispanic, 63.7% White) from a central Texas acute health and primary care facility. RESULTS The amount of time that passed between a patent's initial hospital encounter and a follow-up visit had an effect in predicting both 60-day (OR = 1.055) and 90-day (OR = 1.088) hospital readmission. Patient race/ethnicity had an effect in predicting 90-day readmission. Hispanic patients had a lower likelihood of being readmitted after 90 days than being readmitted after 30 days as compared with White, non-Hispanic patients (OR = 0.688). CONCLUSIONS Our study suggests that risk factors identified at 30 days are similar to those at 60 and 90 days, with the exception of follow-up status and race/ethnicity.
Collapse
Affiliation(s)
- Stephanie L Clendennen
- a Department of Health, Human Performance, and Recreation , Baylor University , Waco , TX , USA
| | - Rodney G Bowden
- b Robbins College of Health and Human Sciences , Baylor University , Waco , TX , USA
| | | | - Grant B Morgan
- d Department of Educational Psychology, School of Education , Baylor University , Waco , TX , USA
| | - M Renee Umstattd Meyer
- e Department of Health, Human Performance and Recreation, College of Health and Human Sciences , Baylor University , Waco , TX , USA
| |
Collapse
|
30
|
Eby E, Hardwick C, Yu M, Gelwicks S, Deschamps K, Xie J, George T. Predictors of 30 day hospital readmission in patients with type 2 diabetes: a retrospective, case-control, database study. Curr Med Res Opin 2015; 31:107-14. [PMID: 25369567 DOI: 10.1185/03007995.2014.981632] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess factors predictive of all-cause, 30 day hospital readmission among patients with type 2 diabetes in the United States. METHODS A retrospective, case-control study using deidentified Humedica electronic health record data was conducted to identify patients ≥18 years old with ≥6 months of data prior to index hospitalization (pre-period) and ≥30 days of data after discharge (post-period). Combined methods of bootstrap resampling and stepwise logistic regression were used to identify factors associated with readmission. RESULTS Among 52,070 patients with type 2 diabetes and an initial hospitalization for any reason, 5201 (10.0%) patients were readmitted within 30 days and 46,869 (90.0%) patients showed no evidence of readmission. Diabetic treatment escalation; race; type 2 diabetes diagnosis prior to the index stay; pre-period heart failure; and number of pre-period, inpatient healthcare visits were among the strongest predictors of 30 day readmission. From a receiver-operating characteristic plot (mean area under curve of 0.693), the predictive accuracy of the final logistic regression model is considered modest. This result might be due to the unavailability of some variables or data. CONCLUSIONS These results highlight the importance of the appropriate recognition of and treatment for type 2 diabetes, prior to and during hospitalization and following discharge, in order to impact a subsequent hospitalization. In our analysis, escalation of diabetic treatments (especially those escalated from having no records of anti-diabetic medications to treatment with insulin) was the strongest predictor of 30 day readmission. Limitations of this study include the fact that hospitalizations and other encounters, outside the Humedica network, were not captured in this analysis.
Collapse
Affiliation(s)
- Elizabeth Eby
- Former employee of Eli Lilly and Company , Indianapolis, IN , USA
| | | | | | | | | | | | | |
Collapse
|
31
|
Barber RD, Coulourides Kogan A, Riffenburgh A, Enguidanos S. A role for social workers in improving care setting transitions: a case study. SOCIAL WORK IN HEALTH CARE 2015; 54:177-92. [PMID: 25760487 PMCID: PMC5479582 DOI: 10.1080/00981389.2015.1005273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
High 30-day readmission rates are a major burden to the American medical system. Much attention is on transitional care to decrease financial costs and improve patient outcomes. Social workers may be uniquely qualified to improve care transitions and have not previously been used in this role. We present a case study of an older, dually eligible Latina woman who received a social work-driven transition intervention that included in-home and telephone contacts. The patient was not readmitted during the six-month study period, mitigated her high pain levels, and engaged in social outings once again. These findings suggest the value of a social worker in a transitional care role.
Collapse
Affiliation(s)
- Ruth D Barber
- a Davis School of Gerontology, University of Southern California , Los Angeles , California , USA
| | | | | | | |
Collapse
|
32
|
Navratil-Strawn JL, Hawkins K, Wells TS, Ozminkowski RJ, Hartley SK, Migliori RJ, Yeh CS. An Emergency Room Decision-Support Program That Increased Physician Office Visits, Decreased Emergency Room Visits, and Saved Money. Popul Health Manag 2014; 17:257-64. [DOI: 10.1089/pop.2013.0117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
McHugh MD, Berez J, Small DS. Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing. Health Aff (Millwood) 2014; 32:1740-7. [PMID: 24101063 DOI: 10.1377/hlthaff.2013.0613] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.
Collapse
|
34
|
Gu Q, Koenig L, Faerberg J, Steinberg CR, Vaz C, Wheatley MP. The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations. Health Serv Res 2014; 49:818-37. [PMID: 24417309 PMCID: PMC4231573 DOI: 10.1111/1475-6773.12150] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. DATA SOURCES/STUDY SETTING Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. STUDY DESIGN Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. PRINCIPAL FINDINGS Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. CONCLUSIONS Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations.
Collapse
Affiliation(s)
- Qian Gu
- Econometrica Inc.Bethesda, MD
| | - Lane Koenig
- KNG Health Consulting, LLC15245 Shady Grove Road, Suite 305, Rockville, MD 20850
| | - Jennifer Faerberg
- Clinical Transformation Unit, Association of American Medical CollegesWashington, DC
| | | | | | - Mary P Wheatley
- Quality and Physician Payment Policies, Association of American Medical CollegesWashington, DC
| |
Collapse
|
35
|
Moore CD, Gao K, Shulan M. Racial, Income, and Marital Status Disparities in Hospital Readmissions Within a Veterans-Integrated Health Care Network. Eval Health Prof 2013; 38:491-507. [PMID: 23811693 DOI: 10.1177/0163278713492982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hospital readmission is an important indicator of health care quality and currently used in determining hospital reimbursement rates by Centers for Medicare & Medicaid Services. Given the important policy implications, a better understanding of factors that influence readmission rates is needed. Racial disparities in readmission have been extensively studied, but income and marital status (a postdischarge care support indicator) disparities have received limited attention. By employing three Poisson regression models controlling for different confounders on 8,718 patients in a veterans-integrated health care network, this study assessed racial, income, and martial disparities in relation to total number of readmissions. In contrast to other studies, no racial and income disparities were found, but unmarried patients experienced significantly more readmissions: 16%, after controlling for the confounders. These findings render unique insight into health care policies aimed to improve race and income disparities, while challenging policy makers to reduce readmissions for those who lack family support.
Collapse
Affiliation(s)
- Crystal Dea Moore
- Department of Social Work, Skidmore College, Saratoga Springs, NY, USA
| | - Kelly Gao
- Department of Social Work, Skidmore College, Saratoga Springs, NY, USA
| | - Mollie Shulan
- Geriatrics and Extended Care, Stratton VA Medical Center, Albany, NY, USA Albany Medical College, Albany, NY, USA
| |
Collapse
|
36
|
Predicting 30-day all-cause hospital readmissions. Health Care Manag Sci 2013; 16:167-75. [DOI: 10.1007/s10729-013-9220-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
|