Does Reducing Length of Stay Increase Rehospitalization of Medicare Fee-for-Service Beneficiaries Discharged to Skilled Nursing Facilities?

被引:32
作者
Unruh, Mark A. [1 ,2 ]
Trivedi, Amal N. [3 ,4 ]
Grabowski, David C. [5 ]
Mor, Vincent [3 ]
机构
[1] Weill Cornell Med Coll, Ctr Healthcare Informat & Policy, New York, NY USA
[2] Weill Cornell Med Coll, Dept Publ Hlth, New York, NY USA
[3] Brown Univ, Alpert Med Sch, Dept Hlth Serv Policy & Practice, Providence, RI 02912 USA
[4] Providence Vet Affairs Med Ctr, Res Enhancement Award Program, Providence, RI USA
[5] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA
关键词
Medicare; quality of care; skilled nursing facilities; length of stay; rehospitalization; OUTCOMES; CARE; READMISSION; ARTHROPLASTY; PAYMENT;
D O I
10.1111/jgs.12411
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objectives To analyze the relationship between length of stay and rehospitalization. Design Retrospective cohort study. Setting Six thousand five hundred thirty-seven hospitals nationwide from January 1999 through September 2005. Participants Medicare fee-for-service beneficiaries associated with 2,101,481 hospitalizations. Measurements Thirty-day rehospitalization derived from Medicare hospital claims using the implementation of Medicare's post-acute care transfer policy as a quasi-experiment. Results Medicare's post-acute care transfer policy led to immediate declines in length of stay. A 1-day decrease in length of stay was associated with an absolute increase in 30-day rehospitalization of 1.56 percentage points (95% confidence interval (CI) = 0.30-2.82) for acute myocardial infarction (AMI) with major complications and 0.81 percentage points (95% CI = 0.03-1.60) for kidney infection or urinary tract infection (UTI) without major complications. Individuals hospitalized for AMI without major complications, heart failure, or kidney infection or UTI with major complications had no increase in 30-day rehospitalization. Conclusion A 1-day reduction in hospital length of stay was not consistently associated with a higher rate of rehospitalization.
引用
收藏
页码:1443 / 1448
页数:6
相关论文
共 24 条
[1]  
[Anonymous], 1998, FED REG, V63, P40954
[2]   The effect of decreasing length of stay on discharge destination and readmission after coronary bypass operation [J].
Bohmer, RMJ ;
Newell, J ;
Torchiana, DF .
SURGERY, 2002, 132 (01) :10-15
[3]   An Early Look At A Four-State Initiative To Reduce Avoidable Hospital Readmissions [J].
Boutwell, Amy E. ;
Johnson, Marian Bihrle ;
Rutherford, Patricia ;
Watson, Sam R. ;
Vecchioni, Nancy ;
Auerbach, Bruce S. ;
Griswold, Paula ;
Noga, Patricia ;
Wagner, Carol .
HEALTH AFFAIRS, 2011, 30 (07) :1272-1280
[4]   Trends in Length of Stay and Short-term Outcomes Among Medicare Patients Hospitalized for Heart Failure, 1993-2006 [J].
Bueno, Hector ;
Ross, Joseph S. ;
Wang, Yun ;
Chen, Jersey ;
Vidan, Maria T. ;
Normand, Sharon-Lise T. ;
Curtis, Jeptha P. ;
Drye, Elizabeth E. ;
Lichtman, Judith H. ;
Keenan, Patricia S. ;
Kosiborod, Mikhail ;
Krumholz, Harlan M. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2010, 303 (21) :2141-2147
[5]   VARIATIONS IN LENGTH OF STAY AND OUTCOMES FOR 6 MEDICAL AND SURGICAL CONDITIONS IN MASSACHUSETTS AND CALIFORNIA [J].
CLEARY, PD ;
GREENFIELD, S ;
MULLEY, AG ;
PAUKER, SG ;
SCHROEDER, SA ;
WEXLER, L ;
MCNEIL, BJ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 266 (01) :73-79
[6]   Impact of early discharge after coronary artery bypass graft surgery on rates of hospital readmission and death [J].
Cowper, PA ;
Peterson, ED ;
DeLong, ER ;
Jollis, JG ;
Muhlbaier, LH ;
Mark, DB .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 30 (04) :908-913
[7]   Total Knee Arthroplasty Volume, Utilization, and Outcomes Among Medicare Beneficiaries, 1991-2010 [J].
Cram, Peter ;
Lu, Xin ;
Kates, Stephen L. ;
Singh, Jasvinder A. ;
Li, Yue ;
Wolf, Brian R. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2012, 308 (12) :1227-1236
[8]   Clinical Characteristics and Outcomes of Medicare Patients Undergoing Total Hip Arthroplasty, 1991-2008 [J].
Cram, Peter ;
Lu, Xin ;
Kaboli, Peter J. ;
Vaughan-Sarrazin, Mary S. ;
Cai, Xueya ;
Wolf, Brian R. ;
Li, Yue .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2011, 305 (15) :1560-1567
[9]   Disability profile and health care costs of medicare beneficiaries under age sixty-five [J].
Foote, SM ;
Hogan, C .
HEALTH AFFAIRS, 2001, 20 (06) :242-253
[10]   Are All Readmissions Bad Readmissions?. [J].
Gorodeski, Eiran Z. ;
Starling, Randall C. ;
Blackstone, Eugene H. .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (03) :297-298