Impact of the Medicare hospital readmissions reduction program on vulnerable populations
Impact of the Medicare hospital readmissions reduction program on vulnerable populations
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DOI：
10.1186/s12913-019-4645-5
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发表时间：
2019-11-14
影响因子：
2.8
通讯作者：
Pachamanova, Dessislava
中科院分区：
文献类型：
--
作者：
Gai, Yunwei;Pachamanova, Dessislava
背景减少再入院计划（HRRP）是由2010年《患者保护和平价医疗法案》（ACA）建立的，旨在减少过度的再入院，降低医疗成本，改善患者安全和预后。虽然研究已经审查了该政策的总体影响和不同类型医院的差异，但研究仅限于其对不同类型弱势群体的影响。本研究的目的是分析HRRP对四类弱势人群中三种目标疾病（急性心肌梗死、心力衰竭和肺炎）再入院的影响，包括低收入患者、低收入或医疗补助患者比例较高的医院所服务的患者以及Elixhauser合并症指数评分最高四分位数的高风险患者。患者和医院信息的数据来自全国再入院数据库（NRD），其中包含2010-2014年期间27个州社区医院的所有出院病例。使用差异中的差异（DD）模型，线性概率回归进行了整个样本和子样本的病人和医院，以隔离的影响，HRRP对弱势群体。使用处理组和对照组的多种组合以及三重差异（DDD）方法检测结果的稳健性。所有型号均针对患者和医院特征进行控制。结果：总体和弱势人群的再入院率在统计学上显著降低，特别是在低收入患者和高危患者比例最大的医院中的急性心肌梗死患者。还有证据表明，与私人保险患者相比，医疗保险患者中的非目标条件具有溢出效应。结论HRRP似乎已经创造了正确的激励措施，减少再入院，不仅整体，而且对弱势群体，积累社会效益，除了以前发现的成本降低。由于再入院率的降低在病人和医院群体之间并不一致，根据医院病人和社区的社会经济地位调整政策可能会有好处。
Background The Hospital Readmissions Reduction Program (HRRP) was established by the 2010 Patient Protection and Affordable Care Act (ACA) in an effort to reduce excess hospital readmissions, lower health care costs, and improve patient safety and outcomes. Although studies have examined the policy's overall impacts and differences by hospital types, research is limited on its effects for different types of vulnerable populations. The aim of this study was to analyze the impact of the HRRP on readmissions for three targeted conditions (acute myocardial infarction, heart failure, and pneumonia) among four types of vulnerable populations, including low-income patients, patients served by hospitals that serve a high percentage of low-income or Medicaid patients, and high-risk patients at the highest quartile of the Elixhauser comorbidity index score. Methods Data on patient and hospital information came from the Nationwide Readmission Database (NRD), which contained all discharges from community hospitals in 27 states during 2010-2014. Using difference-in-difference (DD) models, linear probability regressions were conducted for the entire sample and sub-samples of patients and hospitals in order to isolate the effect of the HRRP on vulnerable populations. Multiple combinations of treatment and control groups and triple difference (DDD) methods were used for testing the robustness of the results. All models controlled for the patient and hospital characteristics. Results There have been statistically significant reductions in readmission rates overall as well as for vulnerable populations, especially for acute myocardial infarction patients in hospitals serving the largest percentage of low-income patients and high-risk patients. There is also evidence of spillover effects for non-targeted conditions among Medicare patients compared to privately insured patients. Conclusions The HRRP appears to have created the right incentives for reducing readmissions not only overall but also for vulnerable populations, accruing societal benefits in addition to previously found reductions in costs. As the reduction in the rate of readmissions is not consistent across patient and hospital groups, there could be benefits to adjusting the policy according to the socioeconomic status of a hospital's patients and neighborhood.