Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients.
Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients.
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DOI：
10.1001/jama.2014.8
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发表时间：
2014-02-12
影响因子：
120.7
通讯作者：
Granger, Carl V.
中科院分区：
文献类型：
--
作者：
Ottenbacher, Kenneth J.;Karmarkar, Amol;Graham, James E.;Kuo, Yong-Fang;Deutsch, Anne;Reistetter, Timothy A.;Al Snih, Soham;Granger, Carl V.
The Centers for Medicare and Medicaid Services (CMS) recently identified 30-day readmission after discharge from inpatient rehabilitation facilities as a national quality indicator. Research is needed to determine the rates and factors related to readmission in this patient population. Determine 30-day readmission rates and factors related to readmission for patients receiving post-acute inpatient rehabilitation. Retrospective cohort study. 1,365 post-acute inpatient rehabilitation facilities providing services to Medicare fee-for service beneficiaries. Records for 736,536 post-acute patients discharged from inpatient rehabilitation facilities to the community in 2006 through 2011. Mean age 78.0 (SD = 7.3) years. Sixty-three percent of patients were female and 85.1% were non-Hispanic white. 30-day readmission rates for the six largest diagnostic impairment categories receiving inpatient rehabilitation. These included stroke, lower extremity fracture, lower extremity joint replacement, debility, neurological disorders and brain dysfunction. Mean rehabilitation length of stay was 12.4 (SD = 5.3) days. The overall 30-day readmission rate was 11.8% (95%CI, 11.7%, 11.8%). Rates ranged from 5.8% (95%CI, 5.8%, 5.9%) for patients with lower extremity joint replacement to 18.8% (95%CI, 18.8%, 18.9%). for patients with debility. Rates were highest in men (13.0%; 95%CI, 12.8%, 13.1%), non-Hispanic blacks, (13.8%; 95%CI, 13.5%, 14.1%), dual eligible beneficiaries (15.1%; 95%CI, 14.9%, 15.4%), and in patients with tier 1 comorbidities (25.6%; 95%CI, 24.9%, 26.3%). Higher motor and cognitive functional status were associated with lower hospital readmission rates across the six impairment categories. Variability in adjusted readmission rates by state ranged from 9.2% to 13.6%. Approximately 50% of patients who were rehospitalized within the 30-day period were readmitted within 11 days of discharge. MS-DRG codes for heart failure, urinary tract infection, pneumonia, septicemia, nutritional and metabolic disorders, esophagitis, gastroenteritis and digestive disorders were common reasons for readmission. Among post-acute rehabilitation facilities providing services to Medicare fee-for-service beneficiaries, 30-day readmission rates ranged from 5.8% to 18.8% for selected impairment groups. Further research is needed to understand the reasons for readmission.
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DOI：
10.1097/phm.0b013e31827441bc
发表时间：
2013-01
影响因子：
3
作者：
Galloway RV;Granger CV;Karmarkar AM;Graham JE;Deutsch A;Niewczyk P;DiVita MA;Ottenbacher KJ
通讯作者：
Ottenbacher KJ
DOI：
10.1377/hlthaff.2012.1262
发表时间：
2013-05
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Chandra A;Dalton MA;Holmes J
通讯作者：
Holmes J
影响因子：
--
作者：
Chen, Lena M.;Jha, Ashish K.;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.
DOI：
10.1161/circoutcomes.109.883256
发表时间：
2009-09-01
影响因子：
6.9
作者：
Krumholz, Harlan M.;Merrill, Angela R.;Drye, Elizabeth E.
通讯作者：
Drye, Elizabeth E.
影响因子：
158.5
作者：
Chan, L;Koepsell, TD;Stolov, WC
通讯作者：
Stolov, WC