The Effect of the Hospital Readmission Reduction Program on the Duration of Observation Stays: Using Regression Discontinuity to Estimate Causal Effects.
The Effect of the Hospital Readmission Reduction Program on the Duration of Observation Stays: Using Regression Discontinuity to Estimate Causal Effects.
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DOI：
10.5334/egems.197
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发表时间：
2017-12-15
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影响因子：
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通讯作者：
Savitz, Lucy
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文献类型：
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作者：
Albritton, Jordan;Belnap, Thomas;Savitz, Lucy
研究目的：确定医院是否会增加因心力衰竭入院后的观察时间，以避免医院再入院减少计划可能产生的付款处罚。研究设计：医院再入院减少计划采用 30 天的截止时间，在此之后，再入院不再受到处罚。鉴于这种看似任意的截断，我们使用断点回归设计，这是一种准实验研究设计，可用于做出因果推断。 研究人群：高价值医疗合作组织包括覆盖全国 57% 医院转诊区域的成员医疗保健系统。我们使用的医疗保险索赔数据包括居住在这些地区的所有患者。该研究纳入了2012年1月1日至2015年6月30日因心力衰竭入院以及随后60天内观察的患者。我们排除了一年内心力衰竭再入院次数少于 25 次或一年内观察次数少于 5 次以及随后观察的患者在另一家医院住院的医院。 主要发现：总体而言，观察时间的 30 天截止点、观察时间超过 12 小时的百分比或观察时间超过 24 小时的百分比没有不连续性。在子分析中，非处罚医院的不连续性非常显着。结论：研究结果揭示了 HRRP 导致一些非处罚医院观察时间延长的证据。
RESEARCH OBJECTIVE: Determine whether hospitals are increasing the duration of observation stays following index admission for heart failure to avoid potential payment penalties from the Hospital Readmission Reduction Program.STUDY DESIGN: The Hospital Readmission Reduction Program applies a 30-day cutoff after which readmissions are no longer penalized. Given this seemingly arbitrary cutoff, we use regression discontinuity design, a quasi-experimental research design that can be used to make causal inferences.POPULATION STUDIED: The High Value Healthcare Collaborative includes member healthcare systems covering 57% of the nation's hospital referral regions. We used Medicare claims data including all patients residing within these regions. The study included patients with index admissions for heart failure from January 1, 2012 to June 30, 2015 and a subsequent observation stay within 60 days. We excluded hospitals with fewer than 25 heart failure readmissions in a year or fewer than 5 observation stays in a year and patients with subsequent observation stays at a different hospital.PRINCIPAL FINDINGS: Overall, there was no discontinuity at the 30-day cutoff in the duration of observation stays, the percent of observation stays over 12 hours, or the percent of observation stays over 24 hours. In the sub-analysis, the discontinuity was significant for non-penalized.CONCLUSION: The findings reveal evidence that the HRRP has resulted in an increase in the duration of observation stays for some non-penalized hospitals.