Variation among primary care physicians in 30-day readmissions

Siddhartha Singh, James Goodwin, Jie Zhou, Yong Fang Kuo, Ann B. Nattinger

Research output: Contribution to journalArticle

Abstract

Background: Whether readmission rates vary by primary care physician (PCP) is unknown, although federal policy holds PCPs accountable for reducing readmissions. Objective: To determine whether 30-day readmission rates vary by PCP. Design: Retrospective cohort study using marginal models and multilevel logistic regression with 100% of data on Texas Medicare claims from 2008 to 2015. Setting: Texas. Participants: Patients discharged alive between 1 January 2008 and 30 November 2015 who had a PCP in the prior year and whose PCP had at least 50 admissions in the study period. Measurements: Readmission within 30 days of discharge. Follow-up visits with a PCP within 7 days of discharge were also measured. Results: Between 2012 and 2015, the mean risk-standardized rate of 30-day readmissions was 12.9%. Of 4230 PCPs, 1 had a readmission rate that was significantly higher than the mean and none had a significantly lower rate. The 10th and 90th percentiles of PCP readmission rates were 12.4% and 13.4%, respectively, each only 0.5 percentage point different from the mean. The 99th percentile of PCP readmission rates was 14.0%, 1.1 percentage points higher than the mean. Detecting a 1.1–percentage point difference from the mean adjusted readmission rate would require more than 3500 admissions per PCP per year. Limitations: Only fee-for-service Medicare patients in a single state were included. The authors could not account for con-founders not included in Medicare databases or classify readmissions as avoidable. Conclusion: Variation in readmission rates among PCPs is very low. Programs holding PCPs accountable for readmissions may prove ineffective. Primary Funding Source: National Institutes of Health.

Original languageEnglish (US)
Pages (from-to)749-755
Number of pages7
JournalAnnals of internal medicine
Volume170
Issue number11
DOIs
StatePublished - Jun 4 2019

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Primary Care Physicians
Medicare
Fee-for-Service Plans
National Institutes of Health (U.S.)
Cohort Studies
Retrospective Studies
Logistic Models
Databases

ASJC Scopus subject areas

  • Internal Medicine

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Variation among primary care physicians in 30-day readmissions. / Singh, Siddhartha; Goodwin, James; Zhou, Jie; Kuo, Yong Fang; Nattinger, Ann B.

In: Annals of internal medicine, Vol. 170, No. 11, 04.06.2019, p. 749-755.

Research output: Contribution to journalArticle

Singh, Siddhartha ; Goodwin, James ; Zhou, Jie ; Kuo, Yong Fang ; Nattinger, Ann B. / Variation among primary care physicians in 30-day readmissions. In: Annals of internal medicine. 2019 ; Vol. 170, No. 11. pp. 749-755.
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abstract = "Background: Whether readmission rates vary by primary care physician (PCP) is unknown, although federal policy holds PCPs accountable for reducing readmissions. Objective: To determine whether 30-day readmission rates vary by PCP. Design: Retrospective cohort study using marginal models and multilevel logistic regression with 100{\%} of data on Texas Medicare claims from 2008 to 2015. Setting: Texas. Participants: Patients discharged alive between 1 January 2008 and 30 November 2015 who had a PCP in the prior year and whose PCP had at least 50 admissions in the study period. Measurements: Readmission within 30 days of discharge. Follow-up visits with a PCP within 7 days of discharge were also measured. Results: Between 2012 and 2015, the mean risk-standardized rate of 30-day readmissions was 12.9{\%}. Of 4230 PCPs, 1 had a readmission rate that was significantly higher than the mean and none had a significantly lower rate. The 10th and 90th percentiles of PCP readmission rates were 12.4{\%} and 13.4{\%}, respectively, each only 0.5 percentage point different from the mean. The 99th percentile of PCP readmission rates was 14.0{\%}, 1.1 percentage points higher than the mean. Detecting a 1.1–percentage point difference from the mean adjusted readmission rate would require more than 3500 admissions per PCP per year. Limitations: Only fee-for-service Medicare patients in a single state were included. The authors could not account for con-founders not included in Medicare databases or classify readmissions as avoidable. Conclusion: Variation in readmission rates among PCPs is very low. Programs holding PCPs accountable for readmissions may prove ineffective. Primary Funding Source: National Institutes of Health.",
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