scholarly journals Toward a More Complete Picture of Readmission-Decreasing Initiatives

2021 ◽  
Vol 13 (16) ◽  
pp. 9272
Author(s):  
Na-Eun Cho ◽  
KiHoon Hong
Keyword(s):  
Census Bureau ◽  
Policy Implications ◽  
Readmission Rates ◽  
American Hospital ◽  
American Hospital Association ◽  
Hospital Administrators ◽  
Using Data ◽  
Hospital Compare ◽  
Health Information Sharing

Readmissions are common and costly. This study examines the effectiveness of two initiatives known to help reduce readmissions. Using data from the American Hospital Association, the Census Bureau, and the Center for Medicare and Medicaid Services’ Hospital Compare database, we found that a higher quality of hospital care does not reduce, but in fact increases readmission rates. Although health information sharing decreases readmission rates, the effect is statistically significant only among the lowest-quality hospitals, not among mid- and high-quality hospitals. The results of our study have important policy implications for providers and hospital administrators with respect to efforts to reduce readmission rates.

Abstract 20172: Identifying Hospital Cardiac Services for Acute Myocardial Infarction Using Individual Patient Claims Data

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tiffany E Chang ◽  
Shu-Xia Li ◽  
Isuru Ranasinghe ◽  
Harlan Krumholz
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Claims Data ◽  
Administrative Claims ◽  
Hospital Data ◽  
American Hospital ◽  
American Hospital Association ◽  
Surgical Services ◽  
Chest X Ray ◽  
Using Data

Background: Hospital data on cardiac services provided is restricted to a limited number of services collected by the American Hospital Association (AHA) Survey. We developed an alternative method to identify hospital services using individual patient administrative claims data for acute myocardial infarction (AMI) in the Premier Database. Methods: We first determined inpatient cardiac services relevant for AMI care from guidelines. Then, we identified these services from patient claims using ICD-9, CPT, Medicare Revenue and provider specialty codes. Additionally, Premier Chargemaster and Physician Specialty Codes were used. A hospital was classified as providing a service if they had >5 AMI patient claims for the service in the Premier database from 2009-2011. To measure the accuracy of the claims based method, we compared the percentage of hospitals that were shown to provide a service identified through the AHA survey for a subset of services identifiable from both sources. Results: We identified 32 services relevant for AMI care that could be defined using data with inpatient claims among 476 hospitals in the Premier database (Figure). The availability of these services ranged from 100% (for services such as chest x-ray) to 1% for heart transplant service. When compared to the subset of 12 services also collected in the AHA survey, a high percentage of agreement (≥80%) was noted for 10/16 (63%) services (such as a dedicated ED, general CT, coronary angiography, PCI, ICU, pharmacist and physio/OT services). Moderate agreement was seen for one service (coronary care unit), and 5/16 (31%) services showed low agreement (≤50%) (EP testing, inpatient cardiac surgical services, inpatient cardiac rehabilitation, transplant unit, and social worker). Conclusion: It is feasible to use claims data to determine in-hospital AMI services, but the accuracy of the method needs to be investigated further for certain services that have a low degree of agreement in our analysis.

scholarly journals Reduction in Hospitals’ Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities

2019 ◽  
Vol 56 ◽  
pp. 004695801881799
Author(s):  
Shivani Gupta ◽  
Ferhat D. Zengul ◽  
Ganisher K. Davlyatov ◽  
Robert Weech-Maldonado
Keyword(s):  
Hospital Readmission ◽  
Fixed Effects ◽  
Skilled Nursing Facility ◽  
Health Resources ◽  
Estimating Equation ◽  
Readmission Rates ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
American Hospital ◽  
American Hospital Association

Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role in lowering readmissions. Although having a hospital-based skilled nursing facility (HBSNF) in a hospital could help in improving care for patients needing short-term skilled nursing or rehabilitation services, little is known about HBSNFs’ association with hospitals’ readmission rates. This study seeks to examine the association between HBSNFs and hospitals’ readmission rates. Data sources included 2007-2012 American Hospital Association Annual Survey, Area Health Resources Files, the Centers for Medicare and Medicaid Services (CMS) Medicare cost reports, and CMS Hospital Compare. The dependent variables were 30-day risk-adjusted readmission rates for acute myocardial infarction (AMI), congestive heart failure, and pneumonia. The independent variable was the presence of HBSNF in a hospital (1 = yes, 0 = no). Control variables included organizational and market factors that could affect hospitals’ readmission rates. Data were analyzed using generalized estimating equation (GEE) models with state and year fixed effects and standard errors corrected for clustering of hospitals over time. Propensity score weights were used to control for potential selection bias of hospitals having a skilled nursing facility (SNF). GEE models showed that the presence of HBSNFs was associated with lower readmission rates for AMI and pneumonia. Moreover, higher SNFs to hospitals ratio in the county were associated with lower readmission rates. These findings can inform policy makers and hospital administrators in evaluating HBSNFs as a potential strategy to lower hospitals’ readmission rates.

Patient satisfaction with doctor and nurse communication varies with patient education level, age, gender, and primary language.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 198-198
Author(s):  
Daniel Curtis McFarland ◽  
Randall F. Holcombe
Keyword(s):  
Patient Satisfaction ◽  
Demographic Data ◽  
Quality Care ◽  
Healthcare Providers ◽  
Census Bureau ◽  
American Hospital ◽  
The Usa ◽  
Perception Of Quality ◽  
English Speaking ◽  
Hospital Compare

198 Background: Hospital Consumer Assessments of Healthcare Providers and Systems (HCAHPS) surveys are used to enhance quality care. Non-random patient satisfaction variance is evident from HCAHPS scores which could be due to varying perception of quality care across demographically heterogeneous areas of the USA. Methods: HCAHPS, hospital bed, and county demographic data were obtained from the Hospital Compare, American Hospital Directory, and US Census Bureau websites, respectively. Multivariate regression modeling was performed for all ten dimensions of HCAHPS scores. Standardized partial regression coefficients were used to assess strengths of predictors (Table). Results: HCAHPS scores were obtained from 3,192 hospitals and demographic data collected from all 3,144 county or county equivalents. While most predictors were significant, ‘bachelor’s degree’ most strongly predicted for favorable satisfaction for MD communication and ‘white alone percent’ most strongly predicted favorable satisfaction for RN communication. Age (over 65), non-English speaking, female, average household size and high school education predicted worse satisfaction with both MD and RN communication. Conclusions: In conclusion, a communication quality gap exists for less educated, non-white, elderly, non-English speaking and female sections of the population. Research should focus on enhancing delivery of quality communication for these subpopulations. [Table: see text]

Who Votes for Medicaid Expansion? Lessons from Maine's 2017 Referendum

2019 ◽  
Vol 44 (4) ◽  
pp. 563-588 ◽  
Author(s):  
David A. Matsa ◽  
Amalia R. Miller
Keyword(s):  
Direct Democracy ◽  
Census Bureau ◽  
Bachelor's Degree ◽  
Medicaid Expansion ◽  
American Hospital ◽  
American Hospital Association ◽  
Self Interest ◽  
Associate's Degree ◽  
Election Results ◽  
Association Data

Abstract Context: In November 2017, Maine became the first state in the nation to vote on a key provision of the Affordable Care Act: the expansion of Medicaid. Methods: This study merged official election results from localities across Maine with Census Bureau and American Hospital Association data to identify characteristics of areas that support Medicaid expansion. Findings: Places with more bachelor's degree holders more often vote in favor, whereas those with more associate's degree graduates tend to vote against. Conditional on education rates, areas with more uninsured individuals who would qualify for expanded coverage tend to vote in favor, while those with more high-income individuals tend to vote against. Also conditional on education rates, greater hospital employment is associated with support for expansion, but the presence of other health professionals, whose incomes might decrease from expansion, is associated with less support. Conclusions: Voting patterns are mostly consistent with economic self-interest, except for the sizable association of bachelor's degree holders with support for Medicaid expansion. Direct democracy can shift Medicaid policy: extrapolating to other states, the model predicts that hypothetical referenda would pass in 5 of the 18 states that had not yet expanded Medicaid at the time of Maine's vote.

Abstract 266: No Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Karen E Joynt ◽  
Deepak L Bhatt ◽  
Lee H Schwamm ◽  
Ying Xian ◽  
Paul A Heidenreich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Electronic Health Records ◽  
Clinical Outcomes ◽  
Quality Care ◽  
Health Records ◽  
American Hospital ◽  
American Hospital Association ◽  
Electronic Health

Background: Electronic Health Records (EHRs) may be a key tool for improving the quality of healthcare. They may be particularly important for conditions such as ischemic stroke, in which guidelines are rapidly evolving and timely care of the patient is critical. Methods: We used data from 1,236 hospitals participating in Get With The Guidelines-Stroke, representing 626,473 ischemic strokes between 2007 and 2010, and linked this with the American Hospital Association annual survey to characterize which study hospitals had an EHR. We conducted regression analyses to determine whether hospitals with an EHR demonstrated better performance on quality metrics, length of stay, discharge to home, and mortality. Results: 511 hospitals had an EHR by the end of the study period. Stroke patients at hospitals with EHRs were younger, more often male and non-white, and had a lower burden of medical comorbidities. Hospitals with EHRs were larger, and more often teaching hospitals and stroke centers than hospitals without EHRs. In unadjusted analyses, patients at hospitals with EHRs were more likely to receive “all-or-none” care (87.9% versus 82.6%, p<0.001), and less likely to have a length of stay over 4 days (42.4% versus 43.9%, p<0.001). However, there were no differences in discharge to a site other than home (50.9% versus 51.1%, p=0.12) or in-hospital mortality (5.3% versus 5.2%, p=0.40). In multivariate analyses, after controlling for patient and hospital characteristics, the presence of an EHR was no longer associated with better quality care, and continued to have no association with clinical outcomes (Table). Conclusions: In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes. Given that these systems often create significant added burden for clinicians, further work to ensure that they are better integrated with care and fully evidence-driven is critical.

scholarly journals Engaging Isolated and Underserved Older Adults in 4Ms Care: Age-Friendly Care, PA

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 315-315
Author(s):  
Diane Berish ◽  
Terry Fulmer
Keyword(s):  
Older Adults ◽  
Social Services ◽  
Care Delivery ◽  
The United States ◽  
Outcome Data ◽  
Policy Implications ◽  
American Hospital ◽  
American Hospital Association ◽  
Clinician Training ◽  
State College

Abstract Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation. They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions. Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program. Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility. This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement. Year two outcome data will be shared. Drs. Hupcey and Fick will provide an overview of the project and its reach. Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated. Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons. Finally, Dr. Garrow will detail a new initiative focused on equity in care. Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.

scholarly journals The Effect of Telemedicine on Access to Acute Stroke Care in Texas: The Story of Age Inequalities

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Karen C. Albright ◽  
Amelia K. Boehme ◽  
Michael T. Mullen ◽  
Tzu-Ching Wu ◽  
Charles C. Branas ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Census Bureau ◽  
Block Group ◽  
Acute Stroke Care ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Time Treatment ◽  
Demographic Estimation

Background. Ischemic stroke is a time sensitive disease with the effectiveness of treatment decreasing over time. Treatment is more likely to occur at Primary Stroke Centers (PSC); thus rapid access to acute stroke care through stand-alone PSCs or telemedicine (TM) is vital for all Americans. The objective of this study is to determine if disparities exist in access to PSCs or the extended access to acute stroke care provided by TM.Methods. Data from the US Census Bureau and the 2010 Neilson Claritas Demographic Estimation Program, American Hospital Association annual survey, and The Joint Commission list of PSCs and survey response data for all hospitals in the state of Texas were used.Results. Over 64% of block groups had 60-minute ground access to acute stroke care. The odds of a block group having 60-minute access to acute stroke care decreased with age, despite adjustment for sex, race, ethnicity, socioeconomic status, urbanization, and total population.Conclusion. Our survey of Texas hospitals found that as the median age of a block group increased, the odds of having access to acute stroke care decreased.

Comparison of Maternal and Neonatal Subspecialty Care Provision by Hospital

2021 ◽  
Author(s):  
Mark A. Clapp ◽  
Sindhu K. Srinivas ◽  
Katy B. Kozhimannil ◽  
William A. Grobman ◽  
Anjali J. Kaimal
Keyword(s):  
High Risk ◽  
Maternal Care ◽  
Placenta Previa ◽  
Neonatal Care ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Key Points ◽  
Using Data ◽  
The Relationship

Objective The aim of the study is to determine the relationship between a hospital's provision of subspecialty neonatal and maternal care. Specifically, we sought to understand where women with high-risk maternal conditions received intrapartum care and estimate the potential transfer burden for those with maternal high-risk conditions delivering at hospitals without subspecialty maternal care. Study Design This is a descriptive study using data from 2015 State Inpatient Databases and the American Hospital Association Annual Survey. Characteristics were compared between hospitals based on the concordance of their maternal and neonatal care. The incidences of high-risk maternal conditions (pre-eclampsia with severe features, placenta previa with prior cesarean delivery, cardiac disease, pulmonary edema, and acute liver failure) were compared. To determine the potential referral burden, the percent of women with high-risk conditions delivering at a hospital without subspecialty maternal care but delivering in a county with a hospital with subspecialty maternal care was calculated. Results The analysis included 486,398 women who delivered at 544 hospitals, of which 104 (19%) and 182 (33%) had subspecialty maternal and neonatal care, respectively. Ninety-eight hospitals provided both subspecialty maternal and neonatal care; however, 84 hospitals provided only subspecialty neonatal care but no subspecialty maternal care. Among high-risk maternal conditions examined, approximately 65% of women delivered at a hospital with subspecialty maternal care. Of the remainder who delivered at a hospital without subspecialty maternal care, one-third were in a county where subspecialty care was present. For women with high-risk conditions who delivered in a county without subspecialty maternal care, the median distance to the closest county with subspecialty care was 52.8 miles (IQR 34.3–87.7 miles). Conclusion Approximately 50% of hospitals with subspecialty neonatal care do not provide subspecialty maternal care. This discordance may present a challenge when both high-risk maternal and neonatal conditions are present. Key Points

Abstract 027: Comparing Changes in Hospital Readmission Rates by Frequency and Total Financial Penalties Over the First Five Years

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Michael P Thompson ◽  
Cameron M Kaplan ◽  
Gloria J Bazzoli ◽  
Teresa M Waters
Keyword(s):  
Hospital Readmission ◽  
Fiscal Year ◽  
Readmission Rates ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Hospital Readmission Rates ◽  
Average Change ◽  
Total Penalty ◽  
Changes In Risk

Objective: To compare changes in risk-standardized readmission rates (RSRRs) for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PN) between hospitals receiving more frequent or higher total penalties under the Hospital Readmission Reduction Program (HRRP) over the first five years (fiscal year [FY] 2013-2017). Methods: Using publically available HRRP penalty data, we categorized hospitals as receiving penalties in all five years vs. fewer than five years. We also summed the penalty amounts over the first five years by hospital and hospitals based on their quartile of summed penalty amount vs. receiving no penalties. Using generalized linear regression, we estimated the average change in RSRRs for AMI, CHF, and PN by penalty frequency (all years vs. not all years) and amount (quartile of total penalty vs. no penalty) between FY 2013 and FY 2017, adjusting for hospital characteristics in the American Hospital Association Annual Survey and Medicare Impact File (both 2009-2011). Results: There were 3,346 hospitals eligible for HRRP penalties between FY 2013 and FY 2017. From this sample, 1,938 hospitals had RSRRs for AMI in both years, 2,821 hospitals had RSRRs for CHF, and 2,876 hospitals had RSRRs for PN. The average change in RSRRs for AMI, CHF, and PN was -2.8%, -2.8%, and -1.4%, respectively. Declines in RSRRs were greater for hospitals receiving penalties in all five years compared to hospitals penalized fewer than five years in AMI (-0.9%, p<0.001), CHF (-0.9%, p<0.001), and PN (-0.4%, p<0.001). Similarly, hospitals receiving the highest total penalties in the first five years of the HRRP had the largest decline in RSRRs compared to hospitals never receiving a penalty for AMI (-1.2%, p<0.001) and CHF (-0.9%, p<0.001), but not for PN (-0.2%, p = not significant). Conclusions: Hospitals receiving more frequent and higher total penalties had greater reductions in RSRRs for AMI and CHF, and to a lesser extent for PN. Our findings suggest that HRRP penalties did not limit hospitals’ ability to reduce readmissions.

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