Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
Department of Health Systems and Population Health, University of Washington School of Public Health and Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Health Serv Res. 2023 Jun;58(3):554-559. doi: 10.1111/1475-6773.14142. Epub 2023 Feb 27.
To evaluate whether Medicare's Hospital Readmissions Reduction Program (HRRP) is associated with increased observation stay use.
A nationally representative sample of fee-for-service Medicare claims, January 2009-September 2016.
Using a difference-in-difference (DID) design, we modeled changes in observation stays as a proportion of total hospitalizations, separately comparing the initial (acute myocardial infarction, pneumonia, heart failure) and subsequent (chronic obstructive pulmonary disease) target conditions with a control group of nontarget conditions. Each model used 3 time periods: baseline (15 months before program announcement), an intervening period between announcement and implementation, and a 2-year post-implementation period, with specific dates defined by HRRP policies.
DATA COLLECTION/EXTRACTION METHODS: We derived a 20% random sample of all hospitalizations for beneficiaries continuously enrolled for 12 months before hospitalization (N = 7,162,189).
Observation stays increased similarly for the initial HRRP target and nontarget conditions in the intervening period (0.01% points per month [95% CI -0.01, 0.3]). Post-implementation, observation stays increased significantly more for target versus nontarget conditions, but the difference is quite small (0.02% points per month [95% CI 0.002, 0.04]). Results for the COPD analysis were statistically insignificant in both policy periods.
The increase in observation stays is likely due to other factors, including audit activity and clinical advances.
评估医疗保险的住院患者再入院率降低计划（HRRP）是否与观察期住院使用率的增加有关。
全国代表性的医疗保险费用服务样本，2009 年 1 月至 2016 年 9 月。
使用差异（DID）设计，我们将观察期住院比例作为一个比例来建模，分别比较初始（急性心肌梗死、肺炎、心力衰竭）和后续（慢性阻塞性肺疾病）目标条件与非目标条件的对照组。每个模型使用 3 个时间段：基线（计划公布前 15 个月）、公告和实施之间的干预期以及实施后 2 年，具体日期由 HRRP 政策定义。
数据收集/提取方法：我们从连续住院 12 个月的所有受益人的住院中提取了 20%的随机样本（N=7162189）。
在干预期间，初始 HRRP 目标和非目标条件的观察期住院率均呈相似增长（每月 0.01%[95%CI-0.01,0.3]）。实施后，目标条件与非目标条件相比，观察期住院率显著增加，但差异很小（每月 0.02%[95%CI0.002,0.04]）。COPD 分析在两个政策期间的结果均无统计学意义。
观察期住院率的增加可能是由于其他因素引起的，包括审核活动和临床进展。
