The influence of changes in activity-based financing on hospital readmissions for the elderly

Activity-based financing of Norwegian hospitals was implemented in 1997. An earlier study shows that when the activity-based component increases, the average length of stay for the elderly is reduced. If this reduction entails premature discharge, an increased activity-based component may have the undesirable side effect of increasing readmission rates. Yearly the Norwegian government decides the size of the activity-based component, and all hospitals face the same size. In this paper, we investigate whether the level of activity-based financing is associated with the readmission rates for acute-care patients above 70 years of age. The sample consisted of 468 010 hospital admissions among elderly patients in the period from 2000 to 2007. Using repeated cross-sectional data extracted from the Norwegian Patient Registry, a Cox regression model was used to estimate factors that may influence the hazard rate of a readmission within 30 days. The overall 30-day readmission rate was 6.6%. The results demonstrate that the activity-based component had no significant effect on the readmission rate. Patient-specific factors such as age, gender, diagnoses, comorbidities, as well as the time trend, were important predictors of readmission rates. We also found a statistically significant random effect of hospitals, although this effect was less substantial than the impact of patient characteristics. Our results show that the effect of the activity-based component on the readmission rate was negligible when it varied between 40% and 60%.Published: Online May 2016. In print August 2016.

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Patient engagement with digital disease management and readmission rates: The case of congestive heart failure

Health Informatics Journal ◽

10.1177/14604582211030959 ◽

2021 ◽

Vol 27 (3) ◽

pp. 146045822110309

Author(s):

Rudin Gjeka ◽

Kirit Patel ◽

Chandra Reddy ◽

Nora Zetsche

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Disease Management ◽

Readmission Rate ◽

Hospital Readmissions ◽

The Elderly ◽

Readmission Rates ◽

Management Platform ◽

High Readmission Rate ◽

Remote Patient

Congestive heart failure (CHF) is one of the most common diagnoses in the elderly United States Medicare (⩾ age 65) population. This patient population has a particularly high readmission rate, with one estimate of the 6-month readmission rate topping 40%. The rapid rise of mobile health (mHealth) presents a promising new pathway for reducing hospital readmissions of CHF, and, more generally, the management of chronic conditions. Using a randomized research design and a multivariate regression model, we evaluated the effectiveness of a hybrid mHealth model—the integration of remote patient monitoring with an applied health technology and digital disease management platform—on 45-day hospital readmissions for patients diagnosed with CHF. We find a 78% decrease in the likelihood of CHF hospital readmission for patients who were assigned to the digital disease management platform as compared to patients assigned to control.

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780 A Systematic Review and Meta-analysis of 30-day Readmission Rates Following Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.357 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S224-S224

Author(s):

Ludwik Branski ◽

Christian Tapking ◽

Gabriel Hundeshagen ◽

Alexis Boson ◽

Victoria G Rontoyanni ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Health Care ◽

Health Care Providers ◽

Readmission Rate ◽

Hospital Readmissions ◽

Random Effect ◽

Total Body Surface Area ◽

Care Providers ◽

Readmission Rates

Abstract Introduction Unplanned hospital readmissions in surgical areas account for high costs and have become an area of focus for health care providers and insurance companies. The aim of this systematic review is to identify the rate and common reasons for unplanned 30-day readmission following burns. Methods This study was performed following the PRISMA guidelines. Pubmed, Web of Science and CENTRAL databases were searched for publications without date or language restrictions. Extracted outcomes included 30-day readmission rate and reasons for readmission. Pooled 30-day readmission rate was estimated from weighted individual study estimates using random-effect models. Pooled estimates for risk factors are reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of eight studies were included into qualitative analysis and six (four adults, two children) into quantitative analysis. The overall readmission rate was 7.4% (95% CI 4.1 - 10.7) in adults and 2.7% (95% CI 2.2 - 3.2) in children. Based on two studies in 112,312 adult burn patients, burn size greater than 20% total body surface area (TBSA) was not a significant predictor of readmission rate (OR 1.75, 95% CI 0.64 – 4.75; NS). The most common reasons were infection/sepsis, wound healing complications, and pain in both adults and children. Conclusions Unplanned readmissions following burns are generally low and appear more common in adults than in pediatric patients. However, only few studies are reporting on 30-day readmission rates following burns. Evidence is limited to support a significant association between greater burn size and higher readmission rates. Applicability of Research to Practice Since cost effectiveness and utilized hospital capacity are becoming an area of focus for improvement in health care, future studies should assess the risk factors of unplanned readmission following burns. Follow-up assessments and outpatient resources, even if not underlined by this data, could reduce readmission rates.

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Framed messages effects on readmissions

Journal of Hospital Administration ◽

10.5430/jha.v5n4p95 ◽

2016 ◽

Vol 5 (4) ◽

pp. 95

Author(s):

Angela P. Halpin ◽

Felicia S. Hodge

Keyword(s):

Hospital Readmissions ◽

Severity Index ◽

The Elderly ◽

Framing Effects ◽

Control Group ◽

Post Discharge ◽

Readmission Rates ◽

Double Blind ◽

Negative Messages ◽

The Impact

Objective: As the eighth leading cause of death in the US, pneumonia (PN) is relevant to the health of the elderly and young. Accountability for readmission is part of the Affordable Care Act’s Hospital Readmissions Reduction Program (RRP), which levies penalties for readmissions. We examined communication using framing effects which can motivate patients’ decisions collaboratively with providers for post discharge care and readmissions prevention. Communication strategies (CS) can facilitate decision-making (DM) about health care choices. The project’s aims were to (1) compare CS of framing effects (positive or negative messages) on the readmission outcome 30 days post discharge; (2) assess PN readmissions decrease 30 days post discharge when CS include the patient/family in decisions about transitions; (3) determine the impact of between patients and HCPs agreement for post hospital care, and (4) examine confounding effects between framing effects and readmission rates of age, PN severity index (PSI), and the number of diagnoses.Methods: A double-blind randomized control trial (RCT) used parallel assignment of 153 PN patients to one of three arms to test the communication framing effects using power analysis, odds ratio, Fischer’s exact and ANOVA. Arm A was the Intervention positive framing group (n = 44), arm B was the Intervention Negative framing group (n = 65), and arm C was the control group (n = 44).Conclusions: Findings suggest that framed messages aid in the reduction of PN readmission rates in hospitals. DM strategies incorporates education and understanding of risk by the patient, so the healthcare teams can encourage and improve readmission outcomes.

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Hospital Readmissions Reduction Program Does Not Provide the Right Incentives: Issues and Remedies

Management Science ◽

10.1287/mnsc.2020.3649 ◽

2020 ◽

Author(s):

Kenan Arifoğlu ◽

Hang Ren ◽

Tolga Tezcan

Keyword(s):

Financial Incentives ◽

Readmission Rate ◽

Hospital Readmissions ◽

Healthcare Management ◽

Readmission Rates ◽

Bundled Payment ◽

Bonus Payments ◽

Reduction Program ◽

The Right ◽

The Impact

The Hospital Readmissions Reduction Program (HRRP) reduces Medicare payments to hospitals with higher than expected readmission rates where the expected readmission rate for each hospital is determined based on the readmission levels at other hospitals. Although similar relative performance-based schemes are shown to lead to socially optimal outcomes in other settings (e.g., cost-cutting efforts), HRRP differs from these schemes in three respects: (i) deviation from the targets is adjusted using a multiplier; (ii) the total financial penalty for a hospital with higher than expected readmission rate is capped; and (iii) hospitals with lower than expected readmission rates do not receive bonus payments. We study three regulatory schemes derived from HRRP to determine the impact of each feature and use a principal-agent model to show that (i) HRRP overpenalizes hospitals with excess readmissions because of the multiplier and its effect can be substantial; (ii) having a penalty cap can curtail the effect of financial incentives and result in a no equilibrium outcome when the cap is too low; and (iii) not allowing bonus payments leads to many alternative symmetric equilibria, including one where hospitals exert no effort to reduce readmissions. These results show that HRRP does not provide the right incentives for hospitals to reduce readmissions. Next, we show that a bundled payment-type reimbursement method, which reimburses hospitals once for each episode of care (including readmissions), leads to socially optimal cost and readmissions reduction efforts. Finally, we show that, when delays to accessing care are inevitable, the reimbursement schemes need to provide additional incentives for hospitals to invest sufficiently in capacity. This paper was accepted by Stefan Scholtes, healthcare management.

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Ceramic-on-Polyethylene Bearing Usage in Primary THA Is Associated with Reduced Readmission Risk for the Medicare Population

The Journal of Hip Surgery ◽

10.1055/s-0038-1642056 ◽

2018 ◽

Vol 02 (01) ◽

pp. 022-032 ◽

Cited By ~ 1

Author(s):

Edmund Lau ◽

Doruk Baykal ◽

Bryan Springer ◽

Steven Kurtz

Keyword(s):

Readmission Rate ◽

Propensity Scores ◽

Cox Regression ◽

Readmission Rates ◽

Related Factors ◽

Propensity Score Stratification ◽

The Impact ◽

Strength Of Association ◽

Readmission Risk ◽

Primary Total Hip Arthroplasty

AbstractThe authors hypothesized that unplanned readmissions, which are often caused by infections and dislocation, may be reduced with ceramic bearing usage. They also sought to confirm that the readmission rates for ceramic bearings were associated with the year of surgery. They identified 245,077 elderly patients (65+) who underwent primary total hip arthroplasty (THA) between 2010 and 2015 with known bearing types (ceramic-on-polyethylene [C-PE] ceramic-on-ceramic [COC], and metal-on-polyethylene [M-PE]) from the Medicare 100% inpatient database. Outcomes included relative risk of 30- and 90-day readmission. Propensity scores were developed to adjust for selection bias in the choice of bearing type at index surgery. Cox regression incorporating propensity score stratification (10 levels) was used to evaluate the impact of bearing selection on outcomes, after adjusting for patient-, hospital-, surgeon-related factors, as well as the year of surgery. With C-PE bearings, the unadjusted (crude) 90-day readmission rate decreased from 8.7% in 2010 to 8.3% in 2015. For COC bearings, the crude 90-day readmission rate decreased from 10.5 to 9.1% from 2010 to 2015. After adjustment, year of surgery was associated with reduced readmission risk for both types of ceramic bearings in 30-day readmissions (p < 0.05) and COC in 90-day readmissions (p < 0.001). The authors also found that C-PE bearings were associated with significantly reduced readmission risk relative to M-PE at 30 days (hazard ratio [HR]: 0.91, p < 0.001) and 90 days (HR: 0.93, p < 0.001). In terms of strength of association with 90-day readmission, however, it was ranked the ninth most associated independent factor. To the authors' knowledge, this is the first study to demonstrate an association between THA implant characteristics (in this case C-PE bearing usage) and reduced readmission rates in this context along with patient- and clinical-related factors. The readmission rates for COC were found to be comparable to M-PE.

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Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20729 ◽

2020 ◽

pp. 1-6

Author(s):

Paul Park ◽

Victor Chang ◽

Hsueh-Han Yeh ◽

Jason M. Schwalb ◽

David R. Nerenz ◽

...

Keyword(s):

Spine Surgery ◽

Spinal Surgery ◽

Readmission Rate ◽

Rating Scale ◽

Short Term ◽

Readmission Rates ◽

Opioid Prescribing ◽

Number Of Patients ◽

Before And After ◽

The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

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Diabetes Discharge Planning and Transitions of Care: A Focused Review

Current Diabetes Reviews ◽

10.2174/1573399814666180711120830 ◽

2019 ◽

Vol 15 (2) ◽

pp. 111-117 ◽

Cited By ~ 9

Author(s):

Robin L. Black ◽

Courtney Duval

Keyword(s):

Patient Outcomes ◽

Hospital Admissions ◽

Discharge Planning ◽

Medication Management ◽

Hospital Readmissions ◽

The United States ◽

Transitions Of Care ◽

Discharge Process ◽

The Impact ◽

Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

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The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽

10.1177/1460408620949725 ◽

2021 ◽

pp. 146040862094972

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory ◽

Gavin Gordon ◽

Fiona Smith ◽

Andrew Jennings

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Hospital Admissions ◽

The Elderly ◽

Primary Outcome Measure ◽

Time To Death ◽

Significant Difference ◽

The Mean ◽

The Impact ◽

Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

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Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension

Heart ◽

10.1136/heartjnl-2017-311857 ◽

2017 ◽

Vol 104 (6) ◽

pp. 487-493 ◽

Cited By ~ 14

Author(s):

Ekrem Yasa ◽

Fabrizio Ricci ◽

Martin Magnusson ◽

Richard Sutton ◽

Sabina Gallina ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Orthostatic Hypotension ◽

Cardiovascular Events ◽

Hospital Admissions ◽

Cox Regression ◽

All Cause Mortality ◽

Unexplained Syncope ◽

The Impact

ObjectiveTo investigate the relationship of hospital admissions due to unexplained syncope and orthostatic hypotension (OH) with subsequent cardiovascular events and mortality.MethodsWe analysed a population-based prospective cohort of 30 528 middle-aged individuals (age 58±8 years; males, 40%). Adjusted Cox regression models were applied to assess the impact of unexplained syncope/OH hospitalisations on cardiovascular events and mortality, excluding subjects with prevalent cardiovascular disease.ResultsAfter a median follow-up of 15±4 years, 524 (1.7%) and 504 (1.7%) participants were hospitalised for syncope or OH, respectively, yielding 1.2 hospital admissions per 1000 person-years for each diagnosis. Syncope hospitalisations increased with age (HR, per 1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01 to 1.12), antihypertensive treatment (HR: 1.26, 95% CI 1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31 to 2.38) and prevalent cardiovascular disease (HR: 1.59, 95% CI 1.14 to 2.23), whereas OH hospitalisations increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After exclusion of 1399 patients with prevalent cardiovascular disease, a total of 473/464 patients were hospitalised for unexplained syncope/OH before any cardiovascular event. Hospitalisation for unexplained syncope predicted coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation (HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis (HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR: 1.22, 95% CI 1.09 to 1.37) and cardiovascular death (HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation (HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality (HR: 1.14, 95% CI 1.01 to 1.30).ConclusionsPatients discharged with the diagnosis of unexplained syncope or OH show higher incidence of cardiovascular disease and mortality with only partial overlap between these two conditions.

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Abstract WP374: Implementation of the Stroke Transition Discharge Center Improves 30-day Readmission Rate

Stroke ◽

10.1161/str.48.suppl_1.wp374 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Susan Quimby ◽

Javicia Peterson-Cole

Keyword(s):

Readmission Rate ◽

Inverse Correlation ◽

Signs And Symptoms ◽

Patient Specific ◽

Readmission Rates ◽

Hospital System ◽

Practice Nurses ◽

Time Period ◽

Number Of Patients ◽

Discharge Center

Background: Stroke patients and their caregivers require formalized education, medications, testing and rehabilitation to assist in prevention of recurrence and of post-stroke complications for optimal outcomes. Objective: The purpose of this program was to evaluate the effect of the Stroke Transition Discharge Center (STDC) on stroke readmission. Methods: The Advanced Practice Nurses (APN) see all stroke and TIA patients one week after discharge from hospital to home or one week after discharge from rehab to home. During the hour encounter, the APN reviews medications, test results, signs and symptoms of stroke, complete education including patient specific risk factors and ensure appropriate follow up. The APN coordinates and facilitates multiple services and disciplines impacting the patient, assuring the most efficient and effective goal-directed activities are provided at the right time and in partnership with all other disciplines providing care. Results: Implementation of the STDC enhances patient outcomes and improves 30-day readmission rates. Prior to our intervention, the readmission rate was 15.3%. After the implementation of the STDC, there was a 61% reduction in 30-day readmission rates to 6%, which is significantly below the hospital system benchmark of 11%. There was an increase in the readmission rate in the first two quarters of 2016 noted. There is an inverse correlation with the number of patients seen in the STDC during the same time period. Further analysis demonstrates that only one readmission in this time period had been seen prior in the STDC. Conclusion: Implementing the Stroke Transition Discharge Center demonstrated a dramatic reduction in 30-day readmission rates. Our data suggests that utilization of the clinic and participation by the patients has a direct and inverse effect on readmissions. Further data will need to be collected to determine if this is a sustained response.

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