An analysis of diagnoses that drive readmission: What can we learn from the hospitals in Southern New England with the highest and lowest readmission performance?

Abstract

Background: The Hospital Readmission Reduction Program was instituted by the Centers for Medicare & Medicaid Services in 2012 to incentivize hospitals to reduce readmissions.

Objective: To examine the most common diagnoses driving readmissions among fee-for-service Medicare beneficiaries in the hospitals with the highest and lowest readmission performance in Southern New England from 2014 to 2016.

Methods: This is a retrospective observational study using publicly available Hospital Compare data and Medicare Part A claims data. Hospitals were ranked based on risk-adjusted excess readmission ratios. Patient demographic and hospital characteristics were compared for the two cohorts using t-tests. The percentages of readmissions in each cohort attributable to the top three readmission diagnoses were examined.

Results: Highest-performing hospitals readmitted a significantly lower percentage of black patients (p=0.03), were less urban (p<0.01), and had higher Hospital Compare Star ratings (p=0.01). Lowest-performing hospitals readmitted higher percentages of patients for sepsis (9.4% [95%CI: 8.8%-10.0%] vs. 8.1% [95%CI: 7.4%-8.7%]) and complications of device, implant, or graft (3.2% [95%CI: 2.5%-3.9%] vs. 0.2% [95%CI: 0.1%-0.6%]), compared to highest-performing hospitals.

Conclusions: Ongoing efforts to improve care transitions may be strengthened by targeting early infection surveillance, promoting adherence to surgical treatment guidelines, and improving communication between hospitals and post-acute care facilities. [Full article available at http://rimed.org/rimedicaljournal-2017-08.asp].

Keywords: Medicare; aging; quality; readmissions.

Figure 1. Geographic information system (GIS) map showing population density (population per square mile) and locations of the highest-performing and lowest-performing hospitals

Note: Highest-performing hospitals had the lowest rates of readmission within 30 days of hospital discharge; lowest-performing hospitals had the highest rates of readmission within 30 days of hospital discharge.

Figure 2. Geographic information system (GIS) map showing mean household income by county and the location of the highest-performing and lowest-performing hospitals

Note: Highest-performing hospitals had the lowest rates of readmission within 30 days of hospital discharge; lowest-performing hospitals had the highest rates of readmission within 30 days of hospital discharge. Data source for mean income: Esri’s 2016 Updated Demographic Data using Census 2010 geographies.

Figure 3. Percent of readmissions due to selected conditions, highest and lowest performing hospitals

Notes: Asterisk indicates that the difference between the highest- and lowest-performing hospitals for that diagnosis category is statistically significant at a p<0.05 level. Highest-performing hospitals had the lowest rates of readmission within 30 days of hospital discharge; lowest-performing hospitals had the highest rates of readmission within 30 days of hospital discharge.