Adverse Discharge Outcomes Associated With the Medicare Hospital Readmissions Reduction Program Among Commercially Insured Adults
| Autor: | Eberechukwu Onukwugha, Aakash Bipin Gandhi, David Alfandre |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Heart Failure education.field_of_study Adolescent business.industry Health Policy Population Public Health Environmental and Occupational Health Against medical advice Middle Aged Medicare Patient Readmission Anticipation Patient Discharge United States Interrupted Time Series Analysis Hospitalization Young Adult Linear regression Humans Medicine business education Aged Demography |
| Zdroj: | Journal for Healthcare Quality. 44:1-10 |
| ISSN: | 1945-1474 1062-2551 |
| Popis: | It is unknown if changes in the rate of discharges against medical advice (DAMA) are related to the implementation of the Medicare Hospital Readmissions Reduction Program (HRRP). We performed an interrupted time series analysis of monthly DAMA rates per 1,000 discharges of all enrolled individuals 18-64 years old with a hospitalization between January 1, 2006, and December 31, 2015, in a commercially insured population. We performed a segmented linear regression with two interruptions: (1) April 2010 to coincide with the passage of the HRRP and (2) October 2012 to coincide with the implementation of HRRP penalties. There were 1,087,812 discharges representing 668,823 individuals over 120 months. The downward trend in monthly DAMA rates was reversed significantly after April 2010 with a sustained 0.1 increase in the monthly rate that continued after the implementation of penalties in October 2012. Allowing for the two interruptions, there was a statistically significant positive trend (0.10; 0.06-0.13, p < .01) in April 2010. Relative to the first interruption, there was no statistically significant change in the slope in October 2012; the estimated slope was -0.04 (-0.08 to 0.002). Monthly DAMA rates increased in anticipation of and after HRRP implementation, suggesting a potential relationship between the HRRP and DAMA. |
| Databáze: | OpenAIRE |
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