Key result
Massachusetts health reform linked to a ~2% increase in 30-day readmissions versus control states.
Why the study?
Does extending health insurance coverage through the Massachusetts health reform reduce 30-day hospital readmissions in adults aged 18-64?
Observational
Yes
Does extending health insurance coverage through the Massachusetts health reform reduce 30-day hospital readmissions in adults aged 18-64?
Effect estimate: OR 1.02 (95% CI 1.01 to 1.04)
p-value: p=<0.05
Extending health insurance coverage alone through the Massachusetts health reform did not reduce 30-day hospital readmissions and slightly increased the odds compared to control states.
Insurance expansion alone may not reduce readmissions; leaves open whether concurrent care coordination is needed.
OBJECTIVES: To analyse changes in overall readmission rates and disparities in such rates, among patients aged 18-64 (those most likely to have been affected by reform), using all payer inpatient discharge databases (hospital episode statistics) from Massachusetts and two control states (New York and New Jersey). DESIGN: Difference in differences analysis to identify the post-reform change, adjusted for secular changes unrelated to reform. SETTING: US hospitals in Massachusetts, New York, and New Jersey. PARTICIPANTS: Adults aged 18-64 admitted for any cause, excluding obstetrical. MAIN OUTCOME MEASURE: Readmissions at 30 days after an index admission. RESULTS: After adjustment for known confounders, including age, sex, comorbidity, hospital ownership, teaching hospital status, and nurse to census ratio, the odds of all cause readmission in Massachusetts was slightly increased compared with control states post-reform (odds ratio 1.02, 95% confidence interval 1.01 to 1.04, P<0.05). Racial and ethnic disparities in all cause readmission rates did not change in Massachusetts compared with control states. In analyses limited to Massachusetts only, there were minimal overall differences in changes in readmission rates between counties with differing baseline uninsurance rates, but black people in counties with the highest uninsurance rates had decreased odds of readmission (0.91, 0.84 to 1.00) compared with black people in counties with lower uninsurance rates. Similarly, white people in counties with the highest uninsurance rates had decreased odds of readmission (0.96, 0.94 to 0.99) compared with white people in counties with lower uninsurance rates. CONCLUSIONS: In the United States, and in Massachusetts in particular, extending health insurance coverage alone seems insufficient to improve readmission rates. Additional efforts are needed to reduce hospital readmissions and disparities in this outcome.
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Lasser et al. (2014) conducted an observational in Any cause admission, excluding obstetrical. Massachusetts health reform vs. Control states (New York and New Jersey) was evaluated on Readmissions at 30 days after an index admission (OR 1.02, 95% CI 1.01 to 1.04, p=<0.05). Massachusetts health reform was associated with a slight increase in the odds of 30-day all-cause readmission compared with control states (OR 1.02; 95% CI 1.01 to 1.04; P<0.05).
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