Hospital Readmissions Reduction Program and Post-Acute Care: Implications for Service Delivery and 30-Day Hospital Readmission.
Chih-Ying Li, Amol Karmarkar, Yu-Li Lin and 2 others
PMID 32660855WHAT IT FOUND
Hospital post-acute care use increased across the study periods, and 30-day readmission fell for heart attack, heart failure and pneumonia.
The link between more post-acute care and readmission varied by condition.
Key findings
01Post-acute care use increased for all three conditions originally targeted by the Hospital Readmissions Reduction Program across the study periods.
02Thirty-day risk-standardized readmission rates decreased for acute myocardial infarction, heart failure and pneumonia across the program periods.
03More post-acute care use was associated with lower 30-day readmission for acute myocardial infarction, heart failure and hip/femur fracture, but with higher readmission for total hip or knee replacement.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used claims data and looked at hospitals, not individual patient responses to a specific discharge intervention. No CMS risk-adjusted readmission model specific to hip/femur fracture was available, so the elective total hip or knee arthroplasty model was used instead. The analysis could not include social determinants, other value-based payment models, or reimbursement policies that may affect post-acute care use and readmission. Results apply only to fee-for-service Medicare beneficiaries and not to people with Medicare Advantage, health maintenance organization plans, or accountable care organizations. Medicare data for 2012 were unavailable, and the authors say this could have affected findings in unknown ways. Total hip and knee arthroplasty was treated as a non-targeted condition for consistency, even though it was added to the program in 2015.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by NIH and U.S. government non-PHS funding.
The easy way to misread this
Do not read this as proof that sending more patients to post-acute care causes fewer readmissions. It is a hospital-level claims study, and the association between post-acute care use and readmission changed by condition and period.