Department of Health Policy & Management School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
National Committee for Quality Assurance (NCQA), Washington, DC, USA.
J Gen Intern Med. 2022 Sep;37(12):3020-3028. doi: 10.1007/s11606-022-07488-3.
Previous studies have identified disparities in readmissions among Medicare beneficiaries hospitalized for the Hospital Readmissions Reduction Program's (HRRP's) priority conditions. Evidence suggests timely follow-up is associated with reduced risk of readmission, but it is unknown whether timely follow-up reduces disparities in readmission.
To assess whether follow-up within 7 days after discharge from a hospitalization reduces risk of readmission and mitigates identified readmission disparities.
A retrospective cohort study using Cox proportional hazards models to estimate the associations between sociodemographic characteristics (race and ethnicity, dual-eligibility status, rurality, and area social deprivation), follow-up, and readmission. Mediation analysis was used to examine if disparities in readmission were mitigated by follow-up.
We analyzed data from 749,402 Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, or pneumonia, and discharged home between January 1 and December 1, 2018.
All-cause unplanned readmission within 30 days after discharge.
Post-discharge follow-up within 7 days of discharge was associated with a substantially lower risk of readmission (HR: 0.52, 95% CI: 0.52-0.53). Across all four HRRP conditions, beneficiaries with dual eligibility and beneficiaries living in areas with high social deprivation had a higher risk of readmission. Non-Hispanic Black beneficiaries had higher risk of readmission after hospitalization for pneumonia relative to non-Hispanic Whites. Mediation analysis suggested that 7-day follow-up mediated 21.2% of the disparity in the risk of readmission between dually and non-dually eligible beneficiaries and 50.7% of the disparity in the risk of readmission between beneficiaries living in areas with the highest and lowest social deprivation. Analysis suggested that after hospitalization for pneumonia, 7-day follow-up mediated nearly all (97.5%) of the increased risk of readmission between non-Hispanic Black and non-Hispanic White beneficiaries.
Improving rates of follow-up could be a strategy to reduce readmissions for all beneficiaries and reduce disparities in readmission based on sociodemographic characteristics.
先前的研究已经确定，医疗保险受益人为医院再入院减少计划（HRRP）的优先条件住院的再入院率存在差异。有证据表明，及时随访与再入院风险降低有关，但尚不清楚及时随访是否会减少再入院率的差异。
评估出院后 7 天内的随访是否降低再入院风险并减轻已确定的再入院差异。
使用 Cox 比例风险模型进行的回顾性队列研究，以估计社会人口统计学特征（种族和民族、双重资格状况、农村地区和地区社会贫困程度）、随访和再入院之间的关联。中介分析用于检查随访是否减轻了再入院的差异。
我们分析了 2018 年 1 月 1 日至 12 月 1 日期间因急性心肌梗死、慢性阻塞性肺疾病、心力衰竭或肺炎住院并出院回家的 749402 名医疗保险付费服务受益人的数据。
出院后 30 天内的所有原因非计划性再入院。
出院后 7 天内进行的出院后随访与再入院风险显著降低相关（HR：0.52，95%CI：0.52-0.53）。在所有四种 HRRP 情况下，双重资格的受益人和生活在社会贫困程度较高地区的受益人的再入院风险较高。与非西班牙裔白人相比，因肺炎住院的非西班牙裔黑人受益人的再入院风险较高。中介分析表明，7 天随访解释了双重和非双重资格受益人的再入院风险差异的 21.2%，以及社会贫困程度最高和最低地区受益人的再入院风险差异的 50.7%。分析表明，因肺炎住院后，7 天随访解释了非西班牙裔黑人与非西班牙裔白人受益人的再入院风险增加的几乎全部（97.5%）。
提高随访率可能是一种策略，可以降低所有受益人的再入院率，并减少基于社会人口统计学特征的再入院差异。
