Postdischarge engagement decreased hospital readmissions in Medicaid populations.
| Autor: | Gao W; AmeriHealth Caritas Family of Companies, 200 Stevens Dr, Philadelphia, PA 19113. Email: wgao@amerihealthcaritas.com., Keleti D, Donia TP, Jones J, Michael KE, Gelzer AD |
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| Jazyk: | angličtina |
| Zdroj: | The American journal of managed care [Am J Manag Care] 2018 Jul 01; Vol. 24 (7), pp. e200-e206. Date of Electronic Publication: 2018 Jul 01. |
| Abstrakt: | Objectives: To investigate the effect of managed care organization (MCO)-implemented postdischarge engagement, supported by other broadly focused interventions, on 30-day hospital readmissions in 6 at-risk Medicaid populations. Study Design: Prospective cohort study. Methods: One-year follow-up analysis of member claims data was performed following an intervention period from January 1, 2014, to December 31, 2014. Postdischarge engagement, supported by additional MCO-initiated interventions, was implemented to reduce 30-day hospital readmissions in Medicaid members having 1 or more dominant chronic conditions. Hospital readmission rates were calculated at baseline and at 1 year post intervention. Bivariable and multivariable generalized estimating equation analysis was used to quantify the likelihood of hospital readmissions. Results: Following implementation, postdischarge engagement rates increased significantly, whereas provider follow-up rates remained unchanged. Increased member engagement resulted in statistically significant reductions in weighted readmission rates enterprise-wide (-10.1%; P <.01) and in 3 of 6 MCOs (-3.9% to -15.8%; P ≤.05) in 2014. Compared with nonparticipants, members who were successfully reached for postdischarge engagement displayed a 33% decrease in 30-day readmissions enterprise-wide (adjusted odds ratio, 0.67; 95% CI, 0.62-0.73) and a comparable decrease (-23% to -39%) in 5 of the 6 MCOs. In this context, greater frequency of postdischarge engagement was associated with proportionally decreased likelihood of readmissions. Conclusions: Postdischarge engagement, against the backdrop of multifaceted MCO-implemented interventions, was associated with significantly reduced hospital readmissions in at-risk Medicaid subjects. Reduced likelihood of readmissions was observed at both the enterprise-wide and plan levels in a manner proportional to the frequency of engagement, a novel reported outcome for this population. |
| Databáze: | MEDLINE |
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