Post-Discharge Services for Different Diagnoses Than Index Hospitalization Predict Decreased 30-Day Readmissions Among Medicare Beneficiaries

Hyo Jung Tak, Li Wu Chen, Fernando A. Wilson, Andrew M. Goldsweig, Dmitry Oleynikov, Michael Hawking, Ya Chen Tina Shih

Research output: Contribution to journalArticle

Abstract

Background: Efforts to reduce hospital readmissions include post-discharge interventions related to the illness treated during the index hospitalization (IH). These efforts may be inadequate because readmissions are precipitated by a wide range of health conditions unrelated to the primary diagnosis of the IH. Objective: To investigate the relationship between post-discharge health services utilization for the same or a different diagnosis than the IH and unplanned 30-day readmission. Design and Participants: The study sample included 583,199 all-cause IHs among 2014 Medicare fee-for-service beneficiaries. For all-cause IH, as well as individually for heart failure, myocardial infarction, and pneumonia IH, we used multivariable logistic regressions to investigate the association between post-discharge services utilization and readmission. Main Measures: The outcome was unplanned 30-day readmission. Primary independent variables were post-discharge services utilization, including institutional outpatient, office-based primary care, office-based specialist, office-based non-physician practitioner, emergency department, home health care, and skilled nursing facility providers. Key Results: Among all-cause IH, 11.7% resulted in unplanned 30-day readmissions, and only 18.1% of readmissions occurred for the same primary diagnosis as IH. A substantial majority of post-discharge health services were utilized for a primary diagnosis differing from IH. Compared with no visit, institutional outpatient visits for the same primary diagnosis as IH (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.31–0.34) and for a different primary diagnosis than IH (OR, 0.36; 95% CI, 0.35–0.37) were similarly strongly associated with decreased unplanned 30-day readmission. Primary care physician, specialist, non-physician practitioner, and home health care showed similar patterns. IH for heart failure, myocardial infarction, and pneumonia manifested similar patterns to all-cause IH both in terms of post-discharge services utilization and in terms of its impact on readmission. Conclusions: To reduce unplanned 30-day readmission more effectively, discharge planning should include post-discharge services to address health conditions beyond the primary cause of the IH.

Original languageEnglish (US)
Pages (from-to)1766-1774
Number of pages9
JournalJournal of general internal medicine
Volume34
Issue number9
DOIs
StatePublished - Sep 15 2019

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Medicare
Hospitalization
Health Services
Pneumonia
Home Health Nursing
Outpatients
Heart Failure
Odds Ratio
Myocardial Infarction
Confidence Intervals
Skilled Nursing Facilities
Fee-for-Service Plans
Patient Readmission
Patient Discharge
Health
Primary Care Physicians
Home Care Services
Hospital Emergency Service
Primary Health Care
Logistic Models

Keywords

  • 30-day readmission
  • Hospital Readmission Reduction Program
  • all-cause index hospitalization
  • post-discharge services utilization
  • service diagnosis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Post-Discharge Services for Different Diagnoses Than Index Hospitalization Predict Decreased 30-Day Readmissions Among Medicare Beneficiaries. / Tak, Hyo Jung; Chen, Li Wu; Wilson, Fernando A.; Goldsweig, Andrew M.; Oleynikov, Dmitry; Hawking, Michael; Shih, Ya Chen Tina.

In: Journal of general internal medicine, Vol. 34, No. 9, 15.09.2019, p. 1766-1774.

Research output: Contribution to journalArticle

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N2 - Background: Efforts to reduce hospital readmissions include post-discharge interventions related to the illness treated during the index hospitalization (IH). These efforts may be inadequate because readmissions are precipitated by a wide range of health conditions unrelated to the primary diagnosis of the IH. Objective: To investigate the relationship between post-discharge health services utilization for the same or a different diagnosis than the IH and unplanned 30-day readmission. Design and Participants: The study sample included 583,199 all-cause IHs among 2014 Medicare fee-for-service beneficiaries. For all-cause IH, as well as individually for heart failure, myocardial infarction, and pneumonia IH, we used multivariable logistic regressions to investigate the association between post-discharge services utilization and readmission. Main Measures: The outcome was unplanned 30-day readmission. Primary independent variables were post-discharge services utilization, including institutional outpatient, office-based primary care, office-based specialist, office-based non-physician practitioner, emergency department, home health care, and skilled nursing facility providers. Key Results: Among all-cause IH, 11.7% resulted in unplanned 30-day readmissions, and only 18.1% of readmissions occurred for the same primary diagnosis as IH. A substantial majority of post-discharge health services were utilized for a primary diagnosis differing from IH. Compared with no visit, institutional outpatient visits for the same primary diagnosis as IH (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.31–0.34) and for a different primary diagnosis than IH (OR, 0.36; 95% CI, 0.35–0.37) were similarly strongly associated with decreased unplanned 30-day readmission. Primary care physician, specialist, non-physician practitioner, and home health care showed similar patterns. IH for heart failure, myocardial infarction, and pneumonia manifested similar patterns to all-cause IH both in terms of post-discharge services utilization and in terms of its impact on readmission. Conclusions: To reduce unplanned 30-day readmission more effectively, discharge planning should include post-discharge services to address health conditions beyond the primary cause of the IH.

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