Patient Readmission Rates For All Insurance Types After Implementation Of The Hospital Readmissions Reduction Program
Patient Readmission Rates For All Insurance Types After Implementation Of The Hospital Readmissions Reduction Program
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DOI：
10.1377/hlthaff.2018.05412
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发表时间：
2019-04-01
期刊：
影响因子：
9.7
通讯作者：
Yeh, Robert W.
中科院分区：
文献类型：
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作者：
Ferro, Enrico G.;Secemsky, Eric A.;Yeh, Robert W.
自实施减少医院再入院计划 (HRRP) 以来，患有该政策所针对疾病（急性心肌梗塞、心力衰竭和肺炎）的医疗保险患者的再入院率有所下降。为了了解 HRRP 的实施是否与所有保险类型（医疗保险、医疗补助和私人）患者的再入院率下降有关，我们使用全国再入院数据库中的信息进行了双重差分分析。我们使用非目标条件作为对照，比较了 HRRP 实施之前 (2010-12) 和之后 (2012-14) 目标条件的季度再入院变化。我们的结果表明，实施 HRRP 后，无论是总体还是个人目标情况，无论是对于医疗保险患者还是对于那些享受医疗补助的患者，再入院率都以显着更快的速度下降。然而，综合医疗补助再入院率仍然高于医疗保险。在整个研究期间，私人保险患者的总体再入院率最低，与非目标条件相比，其下降速度相似。 HRRP 与全国范围内再入院的减少有关，超出了该政策最初针对的医疗保险患者范围。需要进一步研究来了解医院减少再入院率的具体机制。
Since the implementation of the Hospital Readmissions Reduction Program (HRRP), readmissions have declined for Medicare patients with conditions targeted by the policy (acute myocardial infarction, heart failure, and pneumonia). To understand whether HRRP implementation was associated with a readmission decline for patients across all insurance types (Medicare, Medicaid, and private), we conducted a difference-in-differences analysis using information from the Nationwide Readmissions Database. We compared how quarterly readmissions for target conditions changed before (2010-12) and after (2012-14) HRRP implementation, using nontarget conditions as the control. Our results demonstrate that readmissions declined at a significantly faster rate after HRRP implementation not just for Medicare patients but also for those with Medicaid, both in the aggregate and for individual target conditions. However, composite Medicaid readmission rates remained higher than those for Medicare. Throughout the study period privately insured patients had the lowest aggregate readmission rates, which declined at a similar rate compared to nontarget conditions. The HRRP was associated with nationwide readmission reductions beyond the Medicare patients originally targeted by the policy. Further research is needed to understand the specific mechanisms by which hospitals have achieved reductions in readmissions.