Medicare's hospital readmissions reduction program and the rise in observation stays.
Medicare's hospital readmissions reduction program and the rise in observation stays.
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DOI：
10.1111/1475-6773.14142
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发表时间：
2023-06
影响因子：
3.4
通讯作者：
Sabbatini, Amber K.
中科院分区：
文献类型：
--
作者：
Wright, Brad;Parrish, Canada;Basu, Anirban;Maddox, Karen Joynt E.;Liao, Joshua M.;Sabbatini, Amber K.
关键词：
评估医疗保险的医院再入院减少计划（HRRP）是否与观察住院时间增加有关。2009年1月至2016年9月，全国代表性的按服务付费医疗保险索赔样本。使用差异中差异（DID）设计，我们将观察停留时间的变化建模为总住院时间的比例，分别比较初始（急性心肌梗死、肺炎、心力衰竭）和后续（慢性阻塞性肺病）目标疾病与非目标疾病对照组。每个模型使用3个时间段：基线（计划宣布前15个月），宣布和实施之间的间隔期，以及实施后2年的时间段，具体日期由HRRP政策定义。我们从住院前连续入组12个月的受益人（N = 7，162，189）的所有住院病例中抽取了20%的随机样本。在干预期间，初始HRRP目标和非目标条件的观察停留时间增加相似（每月0.01%[95% CI-0.01，0.3]）。实施后，目标条件与非目标条件的观察停留时间显著增加，但差异非常小（每月0.02%[95% CI 0.002，0.04]）。COPD分析结果在两个政策期间均无统计学意义。观察停留时间的增加可能是由于其他因素，包括稽查活动和临床进展。
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. 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.
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影响因子：
158.5
作者：
Zuckerman, Rachael B.;Sheingold, Steven H.;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.
影响因子：
2.6
作者：
Sheehy, Ann M;Kaiksow, Farah;Kind, Amy Jh
通讯作者：
Kind, Amy Jh
影响因子：
9.7
作者：
Cutler, David M.;Ghosh, Kaushik;Rosen, Allison B.
通讯作者：
Rosen, Allison B.
影响因子：
9.7
作者：
Ody, Christopher;Msall, Lucy;Cutler, David M.
通讯作者：
Cutler, David M.
DOI：
10.5334/egems.197
发表时间：
2017-12-15
期刊：
EGEMS (Washington, DC)
影响因子：
--
作者：
Albritton, Jordan;Belnap, Thomas;Savitz, Lucy
通讯作者：
Savitz, Lucy