Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA.
Sol Price School of Public Policy, University of Southern California, Los Angeles, CA.
Med Care. 2019 Oct;57(10):757-765. doi: 10.1097/MLR.0000000000001184.
Medicare's Hospital Readmission Reduction Program (HRRP) penalizes hospitals with elevated 30-day readmission rates for acute myocardial infarction (AMI), heart failure (HF), or pneumonia. To reduce readmissions, hospitals may have increased referrals to skilled nursing facilities (SNFs) and home health care.
Outcomes included 30-day postdischarge utilization of SNF and home health care, including any use as well as days of use. Subjects included Medicare fee-for-service beneficiaries aged 65 years and older who were admitted with AMI, HF, or pneumonia to hospitals subject to the HRRP. Using an interrupted time-series analysis, we compared utilization rates observed after the announcement of the HRRP (April 2010 through September 2012) and after the imposition of penalties (October 2012 through September 2014) with projected utilization rates that accounted for pre-HRRP trends (January 2008 through March 2010). Models included patient characteristics and hospital fixed effects.
For AMI and HF, utilization of SNF and home health care remained stable overall. For pneumonia, observed utilization of any SNF care increased modestly (1.0%, P<0.001 during anticipation; 2.4%, P<0.001 after penalties) and observed utilization of any home health care services declined modestly (-0.5%, P=0.008 after announcement; -0.7%, P=0.045 after penalties) relative to projections. Beneficiaries with AMI and pneumonia treated at penalized hospitals had higher rates of being in the community 30 days postdischarge.
Hospitals might be shifting to more intensive postacute care to avoid readmissions among seniors with pneumonia. At the same time, penalized hospitals' efforts to prevent readmissions may be keeping higher proportions of their patients in the community.
医疗保险的医院再入院率降低计划（HRRP）对急性心肌梗死（AMI）、心力衰竭（HF）或肺炎的 30 天再入院率较高的医院进行处罚。为了减少再入院，医院可能会增加向熟练护理设施（SNF）和家庭保健的转诊。
结果包括 SNF 和家庭保健在出院后 30 天的使用情况，包括使用次数和使用天数。研究对象包括年龄在 65 岁及以上的医疗保险按服务收费受益人的 AMI、HF 或肺炎患者，这些患者被送往受 HRRP 影响的医院。我们使用中断时间序列分析，将在 HRRP 宣布后（2010 年 4 月至 2012 年 9 月）和实施处罚后（2012 年 10 月至 2014 年 9 月）观察到的利用率与考虑到 HRRP 之前趋势（2008 年 1 月至 2010 年 3 月）的预计利用率进行比较。模型包括患者特征和医院固定效应。
对于 AMI 和 HF，SNF 和家庭保健的使用总体保持稳定。对于肺炎，任何 SNF 护理的观察利用率略有增加（预测期内增加 1.0%，P<0.001；处罚后增加 2.4%，P<0.001），任何家庭保健服务的观察利用率略有下降（宣布后下降 0.5%，P=0.008；处罚后下降 0.7%，P=0.045），与预测相比。在受处罚医院接受治疗的 AMI 和肺炎患者，出院后 30 天在社区的比例更高。
医院可能正在转向更密集的急性后期护理，以避免肺炎老年患者的再入院。与此同时，为防止再入院，受处罚的医院可能会让更多的患者留在社区。
