Observation Stays and Readmissions for Older Adults: Implications for Medicare Policies

老年人的观察停留和再入院：对医疗保险政策的影响

基本信息

批准号：
10614922
负责人：
Amber Kathleen Sabbatini
金额：
$ 41万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-15 至 2025-02-28
项目状态：
未结题

项目摘要

SUMMARY Each year, more than 3.4 million Medicare beneficiaries are hospitalized as outpatients under observation. These observation stays have comprised a rapidly increasing proportion of unscheduled hospitalizations among older adults in the US. Controversial Medicare policies, including the Recovery Audit Contractor (RAC) Program and the 2-Midnight Rule, have greatly incentivized hospitals to care for patients via observation instead of an inpatient admission. Additionally, the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with higher-than-expected rates of readmissions for certain conditions, may have also had the untoward consequence of incentivizing hospitals to use observation to avoid readmission penalties. Yet, despite their growing importance in hospital care and the complex policy environment driving their use, few studies have examined how observation stays impact patient’s quality of care and outcomes. Recent evidence shows that 30-day readmissions are increasing among patients with observation stays, despite concomitant declines among inpatients. These disparate trends are significant given that federal quality programs, such as the HRRP, have thus far entirely ignored observation stays in hospital-based care delivery. Similarly, hospitals are not held accountable for other outcomes for patients hospitalized under observation, such as mortality. As a result, there has been little incentive for hospitals to ensure high-quality and effective care for patients with observation stays relative to inpatients. In this context, this study aims to fill critical gaps in our understanding of the consequences the growth of observation stays on patient outcomes. Using longitudinal Medicare claims and quasi-experimental methods, we will specifically answer the following questions: 1) What is the contemporary national landscape of readmissions, post-discharge ED use, mortality, and acute care costs for patients with observation stays, and how does this compare to inpatients across hospitals?; 2) How have current Medicare payment reforms, including the Recover Audit Contractor (RAC) program, 2-Midnight Rule and HRRP, impacted the use of observation stays, and more importantly, have they had unintended consequences on patient outcomes?; 3) Finally, how should observation stays be accounted for in national quality programs to fully reflect the care needs of older adults requiring hospital care? This study will be the most comprehensive examination to date of outcomes for Medicare beneficiaries with observation stays, and is specifically designed to inform clinical and policy decision-making around observation care for older adults.

概括每年，有340万Medicare受益人被视为正在观察的门诊病人住院。这些观察结果已经完成了不定期住院的比例迅速增加在美国的老年人中。有争议的医疗保险政策，包括恢复审计承包商（RAC）计划和2米夜规则，有很大的激励医院来通过观察来照顾患者而不是住院入院。此外，医院再入院计划（HRRP）在某些条件下，惩罚医院的再入院率高于预期的医院，也可能已经激励医院使用观察以避免再入院处罚的不利后果。然而，努力在医院护理和驱动其使用的复杂政策环境中越来越重要，很少有研究研究观察如何影响患者的护理质量和结果。最近的有证据表明，观察住宿的患者中，30天的再入院正在增加伴随的住院患者下降。考虑到联邦质量，这些不同的趋势很重要迄今为止，诸如HRRP之类的计划完全忽略了在基于医院的护理服务中的观察。同样，医院也不对现场住院的患者负责，例如死亡率。结果，医院几乎没有动力确保高质量有效照顾有观察的患者相对于住院患者。在这种情况下，本研究旨在填补关键空白在我们对后果的理解中，观察的增长仍在患者结局上。使用纵向医疗保险主张和准实验方法，我们将专门回答以下问题：1）当代的重新入院率，分期后的使用，死亡率，死亡率，观察患者的急性护理费用，这与跨住院患者相比医院？ 2）当前的医疗保险付款改革，包括恢复审计承包商（RAC）计划，2-MID NIGHT规则和HRRP，影响了观察的使用，更重要的是，他们有对患者预后产生了意想不到的后果吗？ 3）最后，应该如何计算观察在国家质量计划中，完全反映了需要医院护理的老年人的护理需求？这项研究将是Medicare受益人迄今为止最全面的检查留下来，专门设计用于为观察护理围绕临床和政策决策提供信息老年人。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Racial Inequities Across Rural Strata in Acute Stroke Care and In-Hospital Mortality: National Trends Over 6 Years.

DOI：
10.1161/strokeaha.121.035006
发表时间：
2022-05
期刊：
STROKE
影响因子：
8.3
作者：
Hammond, Gmerice;Waken, R. J.;Johnson, Daniel Y.;Towfighi, Amytis;Maddox, Karen E. Joynt
通讯作者：
Maddox, Karen E. Joynt

Medicare's hospital readmissions reduction program and the rise in observation stays.

DOI：
10.1111/1475-6773.14142
发表时间：
2023-06
期刊：
HEALTH SERVICES RESEARCH
影响因子：
3.4
作者：
Wright, Brad;Parrish, Canada;Basu, Anirban;Maddox, Karen Joynt E.;Liao, Joshua M.;Sabbatini, Amber K.
通讯作者：
Sabbatini, Amber K.

Accounting for the Growth of Observation Stays in the Assessment of Medicare's Hospital Readmissions Reduction Program.

DOI：
10.1001/jamanetworkopen.2022.42587
发表时间：
2022-11-01
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Sabbatini, Amber K.;Joynt-Maddox, Karen E.;Liao, Joshua M.;Basu, Anirban;Parrish, Canada;Kreuter, William;Wright, Brad
通讯作者：
Wright, Brad

Experience incentivizing reduction of racial and ethnic disparities in a Medicaid hospital quality incentive program.

体验在医疗补助医院质量激励计划中激励减少种族和民族差异。

DOI：
10.37765/ajmc.2023.89353
发表时间：
2023
期刊：
The American journal of managed care
影响因子：
0
作者：
Erfani,Parsa;Sacco,Cynthia;Shaughnessy,Linda;JoyntMaddox,KarenE;Filice,ClaraE
通讯作者：
Filice,ClaraE

Medicare's Bundled Payments For Care Improvement Advanced Model: Impact On High-Risk Beneficiaries.

医疗保险的捆绑支付改善护理高级模式：对高风险受益人的影响。