Impact of Post-Discharge Care Setting Following Inpatient Hospitalization on Hospital Revisits in a Medicare Population

Abstract

Background: In the current policy environment hospital readmissions are receiving considerable attention due to a provision in the Affordable Care Act (2010), that penalize hospitals through reduced payments for excess readmissions (the hospital readmissions reduction program (HRRP)). This program primarily holds hospitals accountable, although a multitude of factors not directly in control of hospitals can be contributory to readmissions. Of these, whether or not patients are discharged to an appropriate post-discharge care setting can be one contributory factor, and, this study evaluated the association between post-discharge care setting and hospital revisits. Methods: A retrospective analysis of the 2008 Medicare Current Beneficiary Survey (MCBS) was conducted. Three post-discharge care settings were evaluated: 1) routine discharge to home; 2) home with home healthcare; and 3) skilled nursing facility. Two outcomes were assessed: 1) 30-day all-cause hospital readmissions; and 2) 30-day all-cause hospital revisits (combination of inpatient admissions and emergency department visits). Analyses were carried out among patients with hospitalizations for any reason, as well as among a subgroup that were hospitalized for one of seven priority conditions identified in the HRRP. Weighted logistic regression analyses that incorporated information on the complex survey design were conducted. Results: Of the MCBS sample representing 46,048,125 Medicare beneficiaries (unweighted N=11,723), 4.9 percent (N= 2,293,629; unweighted N=670) contributed at least one index hospitalization to the analysis. Among hospitalization for any reason, 30-day all-cause hospital readmissions and revisits was 12.3 percent and 17.8 percent, respectively. The subgroup consisted of 31.8 percent of hospitalizations for any reason (N=730,174; unweighted N=216). Readmissions and revisits in the subgroup were 17.8 percent, and 24.5 percent, respectively. Post-discharge care setting was not significantly associated with either readmissions (P=0.966) or revisits (P=0.728) for hospitalizations for any reason. Findings for the subgroup were similar with no significant association between post-discharge care setting with either readmissions (P=0.850) or revisits (P=0.483). Conclusion: Absence of a difference in readmissions and revisits by post-discharge care setting suggests that the choice of discharge status might be appropriate following an inpatient admission. However, further research with larger sample sizes for conditions in the subgroup both together and separately is recommended.