The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study
The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study
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DOI：
10.1007/s11606-016-3869-x
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发表时间：
2017-01-01
影响因子：
5.7
通讯作者：
McMahon, Laurence F., Jr.
中科院分区：
文献类型：
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作者：
Meddings, Jennifer;Reichert, Heidi;McMahon, Laurence F., Jr.
肺炎、心力衰竭和急性心肌梗死住院后的再入院率根据年龄、性别和医疗合并症进行风险调整，并用于惩罚医院。评估残疾和健康的社会决定因素在当前风险调整之外对特定条件再入院的影响。医疗保险患者的回顾性队列研究使用1)健康与退休研究-医疗保险索赔数据（HRS-CMS）和2)医疗保健成本和利用项目州住院患者数据库（佛罗里达州，华盛顿州）与美国人口普查社区调查（ACS-HCUP）的邮政编码级措施相关联。多水平逻辑回归模型评估了残疾和健康的选定社会决定因素对再入院的影响，超出了当前的风险调整。测量的结果是肺炎、心力衰竭或急性心肌梗死住院后30天的再入院率。HRS-CMS模型包括残疾措施（日常生活活动[ADL]限制、认知障碍、养老院居住、家庭医疗保健使用）和健康的社会决定因素（配偶、子女、财富、医疗补助、种族）。ACS-HCUP模型测量的是邮政编码- 65岁ADL困难居民的百分比、配偶、收入、医疗补助、患者水平和医院水平种族。对于肺炎，3个ADL困难（OR 1.61, CI 1.079-2.391）和之前的家庭医疗保健需求（OR 1.68, CI 1.204-2.355）增加了HRS-CMS模型的再入院率（N = 1631）；ADL困难（OR 1.20, CI 1.063-1.352）和“其他”种族（OR 1.14, CI 1.001-1.301）增加了ACS-HCUP模型的再入院率（N = 27,297）。对于心力衰竭，儿童（OR 0.66, CI 0.437-0.984）和财富（OR 0.53, CI 0.349-0.787）降低了HRS-CMS模型的再入院率（N = 2068），而黑人（OR 1.17, CI 1.056-1.292）和“其他”种族（OR 1.14, CI 1.036-1.260）增加了ACS-HCUP模型的再入院率（N = 37,612）。在hr - cms模型中，对于急性心肌梗死，养老院状态（OR 4.04, CI 1.212-13.440）增加了再入院率（N = 833）；在ACS-HCUP模型中，“其他”患者水平种族（OR 1.18, CI 1.012-1.385）和医院水平种族（OR 1.06, CI 1.001-1.125）增加了再入院率（N = 17,496）。残疾和健康的社会决定因素影响再入院风险，当添加到当前的医疗保险风险调整模型时，但效果因情况而异。
Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals.To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment.Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment.Outcomes measured were readmissions 30 days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Code-percentage of residents 65 years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race.For pneumonia, 3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and 'other' race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66, CI 0.437-0.984) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292) and 'other' race (OR 1.14, CI 1.036-1.260) increased readmission in ACS-HCUP models (N = 37,612). For acute myocardial infarction, nursing home status (OR 4.04, CI 1.212-13.440) increased readmission in HRS-CMS models (N = 833); 'other' patient-level race (OR 1.18, CI 1.012-1.385) and hospital-level race (OR 1.06, CI 1.001-1.125) increased readmission in ACS-HCUP models (N = 17,496).Disability and social determinants of health influence readmission risk when added to the current Medicare risk adjustment models, but the effect varies by condition.