Readmission Patterns Over 90-Day Episodes of Care Among Medicare Fee-for-Service Beneficiaries Discharged to Post-acute Care

Addie Middleton, Yong Fang Kuo, James E. Graham, Amol Karmarkar, Yu Li Lin, James S. Goodwin, Allen Haas, Kenneth J. Ottenbacher

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Objective: Examine readmission patterns over 90-day episodes of care in persons discharged from hospitals to post-acute settings. Design: Retrospective cohort study. Setting: Acute care hospitals. Participants: Medicare fee-for-service enrollees (N = 686,877) discharged from hospitals to post-acute care in 2013-2014. The cohort included beneficiaries >65 years of age hospitalized for stroke, joint replacement, or hip fracture and who survived for 90 days following discharge. Measurements: 90-day unplanned readmissions. Results: The cohort included 127,680 individuals with stroke, 442,195 undergoing joint replacement, and 117,002 with hip fracture. Thirty-day readmission rates ranged from 3.1% for knee replacement patients discharged to home health agencies (HHAs) to 14.4% for hemorrhagic stroke patients discharged to skilled nursing facilities (SNFs). Ninety-day readmission rates ranged from 5.0% for knee replacement patients discharged to HHAs to 26.1% for hemorrhagic stroke patients discharged to SNFs. Differences in readmission rates decreased between stroke subconditions (hemorrhagic and ischemic) and increased between joint replacement subconditions (knee, elective hip, and nonelective hip) from 30 to 90 days across all initial post-acute discharge settings. Conclusions: We observed clear patterns in readmissions over 90-day episodes of care across post-acute discharge settings and subconditions. Our findings suggest that patients with hemorrhagic stroke may be more vulnerable than those with ischemic over the first 30 days after hospital discharge. For patients receiving nonelective joint replacements, readmission prevention efforts should start immediately after discharge and continue, or even increase, over the 90-day episode of care.

Original languageEnglish (US)
Pages (from-to)896-901
Number of pages6
JournalJournal of the American Medical Directors Association
Volume19
Issue number10
DOIs
StatePublished - Oct 2018

Keywords

  • Quality of care
  • health care reform
  • health services research
  • outcomes research

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

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