Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut St, Madison, WI 53726. Email:
Am J Manag Care. 2024 Sep 1;30(9):e266-e273. doi: 10.37765/ajmc.2024.89605.
To assess whether discharging hospitals' self-reported care transition activities (CTAs) were associated with transitional care management (TCM) claims following discharge to the community and whether CTAs and TCM were associated with better patient outcomes.
Cross-sectional study of 424,115 hospitalized Medicare fee-for-service beneficiaries 66 years and older who were discharged to the community in 2017 and attributed to 659 hospitals in the 2017-2018 National Survey of Healthcare Organizations and Systems (response rate, 46.5%). Of these beneficiaries, 76,156 were categorized into a Hospital Readmissions Reduction Program (HRRP) cohort based on admission principal diagnoses.
Using logistic regression, we examined the association between survey-based hospital-reported CTAs and an attributed beneficiary's TCM claim. We assessed the associations between hospital CTAs and TCM and beneficiary spending, utilization, and mortality in linear (continuous outcomes) and logistic (binary outcomes) regressions.
Beneficiaries attributed to hospitals reporting high (top tertile vs bottom tertile) CTA had a higher probability of TCM after discharge by 3 percentage points. TCM was associated with lower 90-day episode spending (-$2803; P < .001) and improved quality (-28.7 30-day readmissions/1000 beneficiaries; P < .001; -29.7 deaths/1000 beneficiaries; P < .001), and greater use of evaluation and management visits (491/1000 beneficiaries; P = .001). Billing for TCM was associated with significantly lower spending, emergency department visits, hospitalizations, readmissions, and 90-day mortality in the HRRP cohort. Significant utilization reductions were estimated for beneficiaries attributed to high-CTA hospitals.
Beyond recent increases in provider TCM compensation and relaxed billing restrictions, hospitals should be encouraged to increase CTA and to enhance care transitions to improve patient outcomes and lower spending.
评估出院医院自我报告的过渡护理活动（CTA）是否与向社区出院后的过渡护理管理（TCM）索赔相关，以及 CTA 和 TCM 是否与更好的患者结果相关。
对 2017 年向社区出院的 66 岁及以上的 424115 名 Medicare 按服务收费受益人的横断面研究，这些受益人与 2017-2018 年全国医疗保健组织和系统调查（回应率为 46.5%）中的 659 家医院有关。在这些受益人中，根据入院主要诊断，有 76156 人被归入医院再入院减少计划（HRRP）队列。
使用逻辑回归，我们检查了基于调查的医院报告的 CTA 与归因受益人的 TCM 索赔之间的关联。我们在线性（连续结果）和逻辑（二进制结果）回归中评估了医院 CTA 和 TCM 与受益人的支出、使用和死亡率之间的关联。
归因于报告 CTA 较高（前三分位与后三分位）的医院的受益人在出院后接受 TCM 的可能性高 3 个百分点。TCM 与 90 天发病支出较低（-2803 美元；P<0.001）和质量改善（30 天再入院率每 1000 名受益人的下降 28.7 次；P<0.001；每 1000 名受益人的死亡人数下降 29.7 次；P<0.001）相关，并增加了评估和管理访问次数（每 1000 名受益人的 491 次；P=0.001）。在 HRRP 队列中，TCM 的计费与支出、急诊就诊、住院、再入院和 90 天死亡率显著降低相关。对于归因于高 CTA 医院的受益人，预计会有显著的使用减少。
除了最近提供者 TCM 补偿的增加和放宽计费限制外，还应鼓励医院增加 CTA 并加强护理过渡，以改善患者结果并降低支出。
