Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities
Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities
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DOI：
10.1377/hlthaff.2017.0211
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发表时间：
2017-09-01
期刊：
影响因子：
9.7
通讯作者：
Tyler, Denise A.
中科院分区：
文献类型：
--
作者：
McHugh, John P.;Foster, Andrew;Tyler, Denise A.
建立熟练护理设施(SNF)的首选提供者网络是医院管理人员使用的一种方法，作为基于价值的支付模式的一部分，用于减少多余的30天重新住院和避免联邦医疗保险罚款或降低受益人的成本。然而，医院也被要求在出院时向患者提供符合联邦医疗保险资格的提供者名单，并且不能明确限制患者的选择。这一要求使SNF网络的开发变得复杂。此外，几乎没有证据表明网络发展在降低重新入院率方面的有效性。我们使用了一种并行的混合方法，将2009-13年期间的联邦医疗保险索赔数据与2015年3月至10月对美国八个市场的医院进行现场访问期间收集的定性数据结合在一起，以检查再住院率的变化以及建立和没有建立正式SNF网络的医院之间的做法差异。作为其护理管理工作的一部分，四家医院建立了正式的SNF网络。从2009年到2013年，这些医院出院患者的再住院率相对下降，比没有正式网络的医院的降幅高4.5个百分点。访谈显示，那些拥有网络的人扩大了与SNF的现有关系，有效地管理了患者数据，并对患者的选择进行了更宽松的解释。
Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009-13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March-October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice.