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 Goodwin, Allen Haas, Kenneth Ottenbacher

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3 Citations (Scopus)

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)
JournalJournal of the American Medical Directors Association
DOIs
StateAccepted/In press - Jan 1 2018

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Subacute Care
Episode of Care
Fee-for-Service Plans
Replacement Arthroplasties
Medicare
Stroke
Home Care Agencies
Skilled Nursing Facilities
Knee
Hip Fractures
Hip
Cohort Studies
Retrospective Studies

Keywords

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

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy

Cite this

@article{e081839392d646a89c0ddbb1686375e4,
title = "Readmission Patterns Over 90-Day Episodes of Care Among Medicare Fee-for-Service Beneficiaries Discharged to Post-acute Care",
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.",
keywords = "health care reform, health services research, outcomes research, Quality of care",
author = "Addie Middleton and Kuo, {Yong Fang} and Graham, {James E.} and Amol Karmarkar and Lin, {Yu Li} and James Goodwin and Allen Haas and Kenneth Ottenbacher",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jamda.2018.03.006",
language = "English (US)",
journal = "Journal of the American Medical Directors Association",
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TY - JOUR

T1 - Readmission Patterns Over 90-Day Episodes of Care Among Medicare Fee-for-Service Beneficiaries Discharged to Post-acute Care

AU - Middleton, Addie

AU - Kuo, Yong Fang

AU - Graham, James E.

AU - Karmarkar, Amol

AU - Lin, Yu Li

AU - Goodwin, James

AU - Haas, Allen

AU - Ottenbacher, Kenneth

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - health care reform

KW - health services research

KW - outcomes research

KW - Quality of care

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U2 - 10.1016/j.jamda.2018.03.006

DO - 10.1016/j.jamda.2018.03.006

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JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

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