Comparative Effectiveness of Risk-Stratified Care Management in Reducing Readmissions in Medicaid Adults With Chronic Disease
| Autor: | Sharon Hewner, Jessica Castner, Yow-Wu B. Wu |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Pediatrics Quality management Population New York Psychological intervention Medicare Patient Readmission 01 natural sciences 03 medical and health sciences Sex Factors 0302 clinical medicine medicine Humans Transitional care 030212 general & internal medicine 0101 mathematics education Aged Retrospective Studies Aged 80 and over Inpatients Risk Management education.field_of_study Medicaid business.industry Health Policy 010102 general mathematics Age Factors Public Health Environmental and Occupational Health Retrospective cohort study Emergency department Middle Aged Quality Improvement Patient Discharge United States Hospitalization Chronic Disease Emergency medicine Managed care Female business |
| Zdroj: | Journal for Healthcare Quality. 38:3-16 |
| ISSN: | 1062-2551 |
| DOI: | 10.1097/01.jhq.0000479826.80326.2e |
| Popis: | Hospitalized adult Medicaid recipients with chronic disease are at risk for rehospitalization within 90 days of discharge, but most research has focused on the Medicare population. The purpose of this study is to examine the impact of population-based care management intensity on inpatient readmissions in Medicaid adults with pre-existing chronic disease. Retrospective analyses of 2,868 index hospital admissions from 2012 New York State Medicaid Data Warehouse claims compared 90-day post-discharge utilization in populations with and without transitional care management interventions. High intensity managed care organization interventions were associated with higher outpatient and lower emergency department post-discharge utilization than low intensity fee-for-service management. However, readmission rates were higher for the managed care cases. Shorter time to readmission was associated with managed care, diagnoses that include heart and kidney failure, shorter length of stay for index hospitalization, and male sex; with no relationship to age. This unexpected result flags the need to re-evaluate readmission as a quality indicator in the complex Medicaid population. Quality improvement efforts should focus on care continuity during transitions and consider population-specific factors that influence readmission. Optimum post-discharge utilization in the Medicaid population requires a balance between outpatient, emergency and inpatient services to improve access and continuity. |
| Databáze: | OpenAIRE |
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