Variation in readmission rates among hospitals following admission for traumatic injury
| Autor: | Dekang Yuan, Jeremy Holden, Laurent G. Glance, Alan Cook, Zihao Huang, Jeffery S. Buzas, David W. Hosmer, Turner M. Osler |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Medicare Logistic regression Patient Readmission 03 medical and health sciences 0302 clinical medicine Outcome Assessment Health Care medicine Hospital discharge Humans Organizational Objectives Decision Making Organizational Quality of Health Care General Environmental Science 030222 orthopedics Adult patients business.industry Process Assessment Health Care 030208 emergency & critical care medicine Hospital level Odds ratio Middle Aged Hospitals Patient Discharge United States Hospitalization Logistic Models Traumatic injury Health Care Surveys Emergency medicine Hospital admission Wounds and Injuries General Earth and Planetary Sciences Female business Random intercept |
| Zdroj: | Injury. 50:173-177 |
| ISSN: | 0020-1383 |
| Popis: | Introduction Readmission following hospital discharge is both common and costly. The Hospital Readmission Reduction Program (HRRP) financially penalizes hospitals for readmission following admission for some conditions, but this approach may not be appropriate for all conditions. We wished to determine if hospitals differed in their adjusted readmission rates following an index hospital admission for traumatic injury. Patients and Methods We extracted from the AHRQ National Readmission Dataset (NRD) all non-elderly adult patients hospitalized following traumatic injury in 2014. We estimated hierarchal logistic regression models to predicted readmission within 30 days. Models included either patient level predictors, hospital level predictors, or both. We quantified the extent of hospital variability in readmissions using the median odds ratio. Additionally, we computed hospital specific risk-adjusted rates of readmission and number of excess readmissions. Results Of the 177,322 patients admitted for traumatic injury 11,940 (6.7%) were readmitted within 30 days. Unadjusted hospital readmission rates for the 637 hospitals in our study varied from 0% to 20%. After controlling for sources of variability the range for hospital readmission rates was between 5.5% and 8.5%. Only 2% of hospitals had a random intercept coefficient significantly different from zero, suggesting that their readmission rates differed from the mean level of all hospitals. We also estimated that in 2014 only 11% of hospitals had more than 2 excess readmissions. Our multilevel model discriminated patients who were readmitted from those not readmitted at an acceptable level (C = 0.74). Conclusions We found little evidence that hospitals differ in their readmission rates following an index admission for traumatic injury. There is little justification for penalizing hospitals based on readmissions after traumatic injury. |
| Databáze: | OpenAIRE |
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