What question did this study set out to answer?

The study aims to evaluate how a broader range of patient characteristics affects hospital readmission rates beyond standard Medicare adjustments.

September 14, 2015JAMA Internal MedicineOpen Access

Patient Characteristics and Differences in Hospital Readmission Rates

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Hospitalized Medicare patients (n=8067). Intervention: Comprehensive patient characteristics adjustment vs. Standard Medicare adjustments. Primary outcome: All-cause readmission within 30 days of discharge (Reduction in difference -2.12 percentage points, 95% CI -3.33 to -0.67, p=.003).

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Key result

Adjusting for patient characteristics reduces the 30-day readmission gap between top and bottom hospitals by ~48%.

Reduction in difference -2.12 percentage points
95% CI -3.33 to -0.67
P=.003
n=8,067

Why the study?

Does adjusting for a comprehensive set of patient characteristics account for differences in 30-day hospital readmission rates compared to standard Medicare adjustments in hospitalized Medicare beneficiaries?

Population

Health and Retirement Study participants enrolled in Medicare who were hospitalized from 2009 to 2012

Comparison

Adjustment for 29 additional patient… vs Standard Medicare adjustments of hospital…

Design

Cohort

Follow-up

30 days

Authors

MBMichael L. BarnettBrigham and Women's Hospital JHJohn HsuHarvard University JMJ. Michael McWilliamsBrigham and Women's Hospital

Discussion

Member takes

Implication

Broader patient characteristics explain nearly half of readmission differences; supports refining Medicare models but should not yet change practice.

Key Points

The study aims to evaluate how a broader range of patient characteristics affects hospital readmission rates beyond standard Medicare adjustments.
Analyzed survey data and Medicare claims from 8,067 hospital admissions (2009-2012) from the Health and Retirement Study.
Assessed 29 patient characteristics as predictors of 30-day readmission rates.
Compared characteristics between participants at hospitals with high vs low readmission rates.
Twenty-two out of 29 patient characteristics significantly predicted readmission beyond standard adjustments (P ≤ .04).
Seventeen characteristics were differently distributed between hospitals in the highest vs lowest quintiles for readmission rates.
The difference in readmission probability between these hospitals was reduced by 48% after adjustment for the 29 characteristics.

Study Design

Type

Observational (n=8,067)

Multicenter

Yes

Structured PICO

Population

Health and Retirement Study (HRS) participants enrolled in Medicare who were hospitalized from 2009 to 2012 (n = 8067 admissions)

Intervention

Adjustment for 29 additional patient characteristics from survey data and claims

Comparator

Standard Medicare adjustments of hospital readmission rates (age, sex, discharge diagnosis, and recent diagnoses)

Outcome

All-cause readmission within 30 days of discharge

Main Result

Effect estimate: Reduction in difference -2.12 percentage points (95% CI -3.33 to -0.67)

Absolute Event Rate: 2.29% vs 4.41%

p-value: p=.003

Patient characteristics not included in Medicare's current risk-adjustment methods explain a large portion of the difference in readmission risk between hospitals, suggesting that hospitals with high readmission rates may be penalized largely based on the patient populations they serve.

Cite This Study

Barnett et al. (2015) conducted an observational in Hospitalized Medicare patients (n=8,067). Comprehensive patient characteristics adjustment vs. Standard Medicare adjustments was evaluated on All-cause readmission within 30 days of discharge (Reduction in difference -2.12 percentage points, 95% CI -3.33 to -0.67, p=.003). Adjusting for comprehensive patient characteristics reduced the difference in 30-day readmission probability between highest and lowest quintile hospitals by 48% (reduction -2.12%; P=0.003).

synapsesocial.com/papers/6a086706ab15ea61dee8d1d2 https://doi.org/10.1001/jamainternmed.2015.4660

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Implication

Broader patient characteristics explain nearly half of readmission differences; supports refining Medicare models but should not yet change practice.

Patient Characteristics and Differences in Hospital Readmission Rates

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Patient Characteristics and Differences in Hospital Readmission Rates

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider