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Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018
BACKGROUND: Previous studies have identified disparities in readmissions among Medicare beneficiaries hospitalized for the Hospital Readmissions Reduction Program’s (HRRP’s) priority conditions. Evidence suggests timely follow-up is associated with reduced risk of readmission, but it is unknown whet...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966846/ https://www.ncbi.nlm.nih.gov/pubmed/35355202 http://dx.doi.org/10.1007/s11606-022-07488-3 |
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author | Anderson, Andrew Mills, Carrie W. Willits, Jacqueline Lisk, Craig Maksut, Jessica L. Khau, Meagan T. Scholle, Sarah Hudson |
author_facet | Anderson, Andrew Mills, Carrie W. Willits, Jacqueline Lisk, Craig Maksut, Jessica L. Khau, Meagan T. Scholle, Sarah Hudson |
author_sort | Anderson, Andrew |
collection | PubMed |
description | BACKGROUND: Previous studies have identified disparities in readmissions among Medicare beneficiaries hospitalized for the Hospital Readmissions Reduction Program’s (HRRP’s) priority conditions. Evidence suggests timely follow-up is associated with reduced risk of readmission, but it is unknown whether timely follow-up reduces disparities in readmission. OBJECTIVE: To assess whether follow-up within 7 days after discharge from a hospitalization reduces risk of readmission and mitigates identified readmission disparities. DESIGN: A retrospective cohort study using Cox proportional hazards models to estimate the associations between sociodemographic characteristics (race and ethnicity, dual-eligibility status, rurality, and area social deprivation), follow-up, and readmission. Mediation analysis was used to examine if disparities in readmission were mitigated by follow-up. PARTICIPANTS: We analyzed data from 749,402 Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, or pneumonia, and discharged home between January 1 and December 1, 2018. MAIN MEASURE: All-cause unplanned readmission within 30 days after discharge. KEY RESULTS: Post-discharge follow-up within 7 days of discharge was associated with a substantially lower risk of readmission (HR: 0.52, 95% CI: 0.52–0.53). Across all four HRRP conditions, beneficiaries with dual eligibility and beneficiaries living in areas with high social deprivation had a higher risk of readmission. Non-Hispanic Black beneficiaries had higher risk of readmission after hospitalization for pneumonia relative to non-Hispanic Whites. Mediation analysis suggested that 7-day follow-up mediated 21.2% of the disparity in the risk of readmission between dually and non-dually eligible beneficiaries and 50.7% of the disparity in the risk of readmission between beneficiaries living in areas with the highest and lowest social deprivation. Analysis suggested that after hospitalization for pneumonia, 7-day follow-up mediated nearly all (97.5%) of the increased risk of readmission between non-Hispanic Black and non-Hispanic White beneficiaries. CONCLUSIONS: Improving rates of follow-up could be a strategy to reduce readmissions for all beneficiaries and reduce disparities in readmission based on sociodemographic characteristics. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-022-07488-3. |
format | Online Article Text |
id | pubmed-8966846 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-89668462022-03-31 Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018 Anderson, Andrew Mills, Carrie W. Willits, Jacqueline Lisk, Craig Maksut, Jessica L. Khau, Meagan T. Scholle, Sarah Hudson J Gen Intern Med Original Research BACKGROUND: Previous studies have identified disparities in readmissions among Medicare beneficiaries hospitalized for the Hospital Readmissions Reduction Program’s (HRRP’s) priority conditions. Evidence suggests timely follow-up is associated with reduced risk of readmission, but it is unknown whether timely follow-up reduces disparities in readmission. OBJECTIVE: To assess whether follow-up within 7 days after discharge from a hospitalization reduces risk of readmission and mitigates identified readmission disparities. DESIGN: A retrospective cohort study using Cox proportional hazards models to estimate the associations between sociodemographic characteristics (race and ethnicity, dual-eligibility status, rurality, and area social deprivation), follow-up, and readmission. Mediation analysis was used to examine if disparities in readmission were mitigated by follow-up. PARTICIPANTS: We analyzed data from 749,402 Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, or pneumonia, and discharged home between January 1 and December 1, 2018. MAIN MEASURE: All-cause unplanned readmission within 30 days after discharge. KEY RESULTS: Post-discharge follow-up within 7 days of discharge was associated with a substantially lower risk of readmission (HR: 0.52, 95% CI: 0.52–0.53). Across all four HRRP conditions, beneficiaries with dual eligibility and beneficiaries living in areas with high social deprivation had a higher risk of readmission. Non-Hispanic Black beneficiaries had higher risk of readmission after hospitalization for pneumonia relative to non-Hispanic Whites. Mediation analysis suggested that 7-day follow-up mediated 21.2% of the disparity in the risk of readmission between dually and non-dually eligible beneficiaries and 50.7% of the disparity in the risk of readmission between beneficiaries living in areas with the highest and lowest social deprivation. Analysis suggested that after hospitalization for pneumonia, 7-day follow-up mediated nearly all (97.5%) of the increased risk of readmission between non-Hispanic Black and non-Hispanic White beneficiaries. CONCLUSIONS: Improving rates of follow-up could be a strategy to reduce readmissions for all beneficiaries and reduce disparities in readmission based on sociodemographic characteristics. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-022-07488-3. Springer International Publishing 2022-03-30 2022-09 /pmc/articles/PMC8966846/ /pubmed/35355202 http://dx.doi.org/10.1007/s11606-022-07488-3 Text en © The Author(s) under exclusive licence to Society of General Internal Medicine 2022 |
spellingShingle | Original Research Anderson, Andrew Mills, Carrie W. Willits, Jacqueline Lisk, Craig Maksut, Jessica L. Khau, Meagan T. Scholle, Sarah Hudson Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018 |
title | Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018 |
title_full | Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018 |
title_fullStr | Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018 |
title_full_unstemmed | Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018 |
title_short | Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018 |
title_sort | follow-up post-discharge and readmission disparities among medicare fee-for-service beneficiaries, 2018 |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966846/ https://www.ncbi.nlm.nih.gov/pubmed/35355202 http://dx.doi.org/10.1007/s11606-022-07488-3 |
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