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BMJ Open. 2017 Jul 13;7(7):e016149. doi: 10.1136/bmjopen-2017-016149.

Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015.

Salerno AM1,2,3, Horwitz LI4,5,6, Kwon JY2, Herrin J7,8, Grady JN2, Lin Z2, Ross JS1,2,9,10, Bernheim SM1,2,10.

Author information

1
Department of Internal Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
2
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.
3
Yale Medical Group, School of Medicine, Yale University, New Haven, Connecticut, USA.
4
Center for Healthcare Innovation and Delivery Science, NYU Langone Medical Center, New York, USA.
5
Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, USA.
6
Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York School of Medicine, New York, USA.
7
Section of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA.
8
Health Research and Educational Trust, Chicago, Illinois, USA.
9
Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, USA.
10
Department of Internal Medicine, Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.

Abstract

OBJECTIVE:

To compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP).

DESIGN:

A retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015.

SETTING:

We examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital's proportion of patients with low socioeconomic status.

PARTICIPANTS:

Admissions for Medicare fee-for-service patients, age ≥65 years, discharged alive, who had a valid five-digit zip code and did not have a principal discharge diagnosis of cancer or psychiatric illness were included, for a total of 52 516 213 index admissions.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Mean hospital-level, all-condition, 30-day risk-adjusted standardised unplanned readmission rate, measured quarterly, along with quarterly rate of change, and an interrupted time series examining: April-June 2010, after HRRP was passed, and October-December 2012, after HRRP penalties were implemented.

RESULTS:

58.0% (SD 15.3) of safety net hospitals and 17.1% (SD 10.4) of non-safety net hospitals' patients were in the lowest quartile of socioeconomic status. The mean safety net hospital standardised readmission rate declined from 17.0% (SD 3.7) to 13.6% (SD 3.6), whereas the mean non-safety net hospital declined from 15.4% (SD 3.0) to 12.7% (SD 2.5). The absolute difference in rates between safety net and non-safety net hospitals declined from 1.6% (95% CI 1.3 to 1.9) to 0.9% (0.7 to 1.2). The quarterly decline in standardised readmission rates was 0.03 percentage points (95% CI 0.03 to 0.02, p<0.001) greater among safety net hospitals over the entire study period, and no differential change among safety net and non-safety net hospitals was found after either HRRP was passed or penalties enacted.

CONCLUSIONS:

Since HRRP was passed and penalties implemented, readmission rates for safety net hospitals have decreased more rapidly than those for non-safety net hospitals.

KEYWORDS:

GENERAL MEDICINE (see Internal Medicine); Health policy; Quality in health care

PMID:
28710221
PMCID:
PMC5541519
DOI:
10.1136/bmjopen-2017-016149
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: AMS, LIH, JYK, JH, JNG, ZL, JSR and SMB receive funding from the Center for Medicare & Medicaid Services to construct quality measures, including the hospital-wide readmission measure. JSR also reports receiving research support through Yale University from Medtronic and Johnson and Johnson to develop methods of clinical trial data sharing, from the Food and Drug Administration (FDA) to develop methods for post-market surveillance of medical devices, and from the Blue Cross Blue Shield Association (BCBSA) to better understand medical technology evidence generation.

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