Variation in the Risk of Readmission Among Hospitals: The Relative Contribution of Patient, Hospital and Inpatient Provider Characteristics
ABSTRACT BACKGROUND The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with excess readmissions. The contribution of patient characteristics, hospital characteristics and provider type to the variation...
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| Published in | Journal of general internal medicine : JGIM Vol. 29; no. 4; pp. 572 - 578 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Boston
Springer US
01.04.2014
Springer Springer Nature B.V |
| Subjects | |
| Online Access | Get full text |
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| Abstract | ABSTRACT
BACKGROUND
The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with excess readmissions. The contribution of patient characteristics, hospital characteristics and provider type to the variation in risk of readmission among hospitals has not been determined.
OBJECTIVE
To describe the variation in risk of readmission among hospitals and partition it by patient characteristics, hospital characteristics and provider type.
DESIGN
Retrospective research design of 100 % Texas Medicare data using multilevel, multivariable models.
SUBJECTS
A total of 514,064 admissions of Medicare beneficiaries to 272 hospitals in Texas for medical diagnoses during the years 2008 and 2009.
MAIN MEASURES
Using hierarchical generalized linear models, we describe the hospital-specific variation in risk of readmission that is attributable to patients characteristics, hospital characteristics and provider type by measuring the variance and intraclass correlation coefficients.
KEY RESULTS
Of the total variation in risk of readmission, only a small amount (0.84 %) is attributed to hospitals. In further analyses modeling the components of this variation among hospitals, differences in patient characteristics in the hospitals explained 56.2 % of the variation. Hospital characteristics and the type of provider explained 9.3 % of the variation among hospitals and 0.08 % of the total variation in risk of readmission.
CONCLUSIONS
Patient characteristics are the largest contributor to variation in risk of readmission among hospitals. Measurable hospital characteristics and the type of inpatient provider contribute little to variation in risk of readmission among hospitals. |
|---|---|
| AbstractList | ABSTRACT
BACKGROUND
The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with excess readmissions. The contribution of patient characteristics, hospital characteristics and provider type to the variation in risk of readmission among hospitals has not been determined.
OBJECTIVE
To describe the variation in risk of readmission among hospitals and partition it by patient characteristics, hospital characteristics and provider type.
DESIGN
Retrospective research design of 100 % Texas Medicare data using multilevel, multivariable models.
SUBJECTS
A total of 514,064 admissions of Medicare beneficiaries to 272 hospitals in Texas for medical diagnoses during the years 2008 and 2009.
MAIN MEASURES
Using hierarchical generalized linear models, we describe the hospital-specific variation in risk of readmission that is attributable to patients characteristics, hospital characteristics and provider type by measuring the variance and intraclass correlation coefficients.
KEY RESULTS
Of the total variation in risk of readmission, only a small amount (0.84 %) is attributed to hospitals. In further analyses modeling the components of this variation among hospitals, differences in patient characteristics in the hospitals explained 56.2 % of the variation. Hospital characteristics and the type of provider explained 9.3 % of the variation among hospitals and 0.08 % of the total variation in risk of readmission.
CONCLUSIONS
Patient characteristics are the largest contributor to variation in risk of readmission among hospitals. Measurable hospital characteristics and the type of inpatient provider contribute little to variation in risk of readmission among hospitals. The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with excess readmissions. The contribution of patient characteristics, hospital characteristics and provider type to the variation in risk of readmission among hospitals has not been determined.BACKGROUNDThe risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with excess readmissions. The contribution of patient characteristics, hospital characteristics and provider type to the variation in risk of readmission among hospitals has not been determined.To describe the variation in risk of readmission among hospitals and partition it by patient characteristics, hospital characteristics and provider type.OBJECTIVETo describe the variation in risk of readmission among hospitals and partition it by patient characteristics, hospital characteristics and provider type.Retrospective research design of 100% Texas Medicare data using multilevel, multivariable models.DESIGNRetrospective research design of 100% Texas Medicare data using multilevel, multivariable models.A total of 514,064 admissions of Medicare beneficiaries to 272 hospitals in Texas for medical diagnoses during the years 2008 and 2009.SUBJECTSA total of 514,064 admissions of Medicare beneficiaries to 272 hospitals in Texas for medical diagnoses during the years 2008 and 2009.Using hierarchical generalized linear models, we describe the hospital-specific variation in risk of readmission that is attributable to patients characteristics, hospital characteristics and provider type by measuring the variance and intraclass correlation coefficients.MAIN MEASURESUsing hierarchical generalized linear models, we describe the hospital-specific variation in risk of readmission that is attributable to patients characteristics, hospital characteristics and provider type by measuring the variance and intraclass correlation coefficients.Of the total variation in risk of readmission, only a small amount (0.84%) is attributed to hospitals. In further analyses modeling the components of this variation among hospitals, differences in patient characteristics in the hospitals explained 56.2% of the variation. Hospital characteristics and the type of provider explained 9.3% of the variation among hospitals and 0.08% of the total variation in risk of readmission.KEY RESULTSOf the total variation in risk of readmission, only a small amount (0.84%) is attributed to hospitals. In further analyses modeling the components of this variation among hospitals, differences in patient characteristics in the hospitals explained 56.2% of the variation. Hospital characteristics and the type of provider explained 9.3% of the variation among hospitals and 0.08% of the total variation in risk of readmission.Patient characteristics are the largest contributor to variation in risk of readmission among hospitals. Measurable hospital characteristics and the type of inpatient provider contribute little to variation in risk of readmission among hospitals.CONCLUSIONSPatient characteristics are the largest contributor to variation in risk of readmission among hospitals. Measurable hospital characteristics and the type of inpatient provider contribute little to variation in risk of readmission among hospitals. The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with excess readmissions. The contribution of patient characteristics, hospital characteristics and provider type to the variation in risk of readmission among hospitals has not been determined. To describe the variation in risk of readmission among hospitals and partition it by patient characteristics, hospital characteristics and provider type. Retrospective research design of 100 % Texas Medicare data using multilevel, multivariable models. A total of 514,064 admissions of Medicare beneficiaries to 272 hospitals in Texas for medical diagnoses during the years 2008 and 2009. Using hierarchical generalized linear models, we describe the hospital-specific variation in risk of readmission that is attributable to patients characteristics, hospital characteristics and provider type by measuring the variance and intraclass correlation coefficients. Of the total variation in risk of readmission, only a small amount (0.84 %) is attributed to hospitals. In further analyses modeling the components of this variation among hospitals, differences in patient characteristics in the hospitals explained 56.2 % of the variation. Hospital characteristics and the type of provider explained 9.3 % of the variation among hospitals and 0.08 % of the total variation in risk of readmission. Patient characteristics are the largest contributor to variation in risk of readmission among hospitals. Measurable hospital characteristics and the type of inpatient provider contribute little to variation in risk of readmission among hospitals.[PUBLICATION ABSTRACT] The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with excess readmissions. The contribution of patient characteristics, hospital characteristics and provider type to the variation in risk of readmission among hospitals has not been determined. To describe the variation in risk of readmission among hospitals and partition it by patient characteristics, hospital characteristics and provider type. Retrospective research design of 100% Texas Medicare data using multilevel, multivariable models. A total of 514,064 admissions of Medicare beneficiaries to 272 hospitals in Texas for medical diagnoses during the years 2008 and 2009. Using hierarchical generalized linear models, we describe the hospital-specific variation in risk of readmission that is attributable to patients characteristics, hospital characteristics and provider type by measuring the variance and intraclass correlation coefficients. Of the total variation in risk of readmission, only a small amount (0.84%) is attributed to hospitals. In further analyses modeling the components of this variation among hospitals, differences in patient characteristics in the hospitals explained 56.2% of the variation. Hospital characteristics and the type of provider explained 9.3% of the variation among hospitals and 0.08% of the total variation in risk of readmission. Patient characteristics are the largest contributor to variation in risk of readmission among hospitals. Measurable hospital characteristics and the type of inpatient provider contribute little to variation in risk of readmission among hospitals. |
| Author | Lin, Yu-Li Kuo, Yong-Fang Singh, Siddhartha Nattinger, Ann B. Goodwin, James S. |
| Author_xml | – sequence: 1 givenname: Siddhartha surname: Singh fullname: Singh, Siddhartha email: ssingh@mcw.edu organization: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin – sequence: 2 givenname: Yu-Li surname: Lin fullname: Lin, Yu-Li organization: Department of Medicine and Sealy Center on Aging, University of Texas Medical Branch – sequence: 3 givenname: Yong-Fang surname: Kuo fullname: Kuo, Yong-Fang organization: Department of Medicine and Sealy Center on Aging, University of Texas Medical Branch – sequence: 4 givenname: Ann B. surname: Nattinger fullname: Nattinger, Ann B. organization: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin – sequence: 5 givenname: James S. surname: Goodwin fullname: Goodwin, James S. organization: Department of Medicine and Sealy Center on Aging, University of Texas Medical Branch |
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BACKGROUND
The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to... The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with... |
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| SubjectTerms | Aged Aged, 80 and over Biological and medical sciences Clinical Competence - standards Cohort Studies Female General aspects Health participants Hospitalization Hospitals - standards Hospitals - trends Humans Inpatients Internal Medicine Male Medical sciences Medicare Medicare - standards Medicare - trends Medicine Medicine & Public Health Original Research Patient admissions Patient Participation - trends Patient Readmission - standards Patient Readmission - trends Public health. Hygiene Public health. Hygiene-occupational medicine Retrospective Studies Risk Factors Texas - epidemiology United States - epidemiology |
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| Title | Variation in the Risk of Readmission Among Hospitals: The Relative Contribution of Patient, Hospital and Inpatient Provider Characteristics |
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