Boggs Elizabeth, Misky Gregory, Scarbro Sharon, Gritz Mark, Tipirneni Renuka, Lindrooth Richard
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA.
J Hosp Med. 2025 Mar;20(3):219-228. doi: 10.1002/jhm.13486. Epub 2024 Aug 20.
Studies have identified higher risk of readmission for patients with Medicaid compared to those with private insurance. Postdischarge follow-up is utilized as an intervention to reduce readmissions in the Medicare population, but it is unclear whether follow-up reduces risk of readmission for patients with Medicaid.
To assess whether follow-up within 30 days of discharge reduces risk of readmission and mitigates readmission disparities based upon insurance status.
This retrospective cohort study used Cox proportional hazard and competing risk models to estimate associations between sociodemographic and clinical characteristics, follow-up, and readmission. We analyzed data from 4281 patients aged 21-64 years with Medicaid or private insurance who were hospitalized from January 2017 to December 2019 for one of five conditions associated with high risk of readmission. Outpatient follow-up within 30 days of discharge and 30-day all-cause readmission were outcomes.
Overall risk of readmission was similar for Medicaid and privately insured patients in this cohort (13.7% and 14.5%, respectively). Patients with Medicaid were 23% points less likely to complete outpatient follow-up within 30 days compared to patients with private insurance (p < .001). However, outpatient follow-up before readmission within 30 days of discharge was not associated with a significant difference in readmission rate (hazard ratio: 1.10, 95% confidence interval: 0.91-1.32) in the overall sample or in analysis stratified by payer.
We found similar rates of readmission for Medicaid and privately insured patients despite significant disparities in postdischarge follow-up. Timely follow-up care alone may not be sufficient as an intervention to reduce readmissions.
研究发现，与拥有私人保险的患者相比，医疗补助计划（Medicaid）患者再次入院的风险更高。出院后随访被用作一种干预措施，以降低医疗保险人群的再入院率，但尚不清楚随访是否能降低医疗补助计划患者的再入院风险。
评估出院后30天内的随访是否能降低再入院风险，并减轻基于保险状况的再入院差异。
这项回顾性队列研究使用Cox比例风险模型和竞争风险模型来估计社会人口统计学和临床特征、随访与再入院之间的关联。我们分析了2017年1月至2019年12月期间因五种与高再入院风险相关的疾病之一而住院的4281名年龄在21 - 64岁之间、拥有医疗补助计划或私人保险的患者的数据。出院后30天内的门诊随访和30天全因再入院情况为研究结果。
该队列中，医疗补助计划患者和私人保险患者的总体再入院风险相似（分别为13.7%和14.5%）。与私人保险患者相比，医疗补助计划患者在30天内完成门诊随访的可能性低了２３个百分点（p < 0.001）。然而，出院后30天内再入院前的门诊随访与总体样本或按付款人分层分析中的再入院率差异无统计学意义（风险比：1.10，95%置信区间：0.91 - 1.32）。
尽管出院后随访存在显著差异，但我们发现医疗补助计划患者和私人保险患者的再入院率相似。仅及时的随访护理作为降低再入院率的干预措施可能并不足够。
