EVALUATION OF THE IMPACT OF AN INPATIENT DISCHARGE CARE PLANNING INTERVENTION ON HOSPITAL 30-DAY READMISSIONS AND COSTS IN A MEDICARE POPULATION
Author(s)
Shockley E, Jones A
Ascension, Nashville, TN, USA
OBJECTIVES : Inpatient hospital stays are expensive, and studies indicate that many are preventable. This study evaluated the effect of a care planning intervention initiated at discharge on 30-day readmissions and costs in a Medicare population. METHODS : All hospital admissions in 2018 for 4968 beneficiaries attributed to a CMS Medicare Shared Savings Program (MSSP) , except those for diagnoses considered always planned, were identified as index admissions using administrative claims data. For patients with multiple possible index admissions, only the first admission was chosen as the index admission. A Bayesian GLM was constructed to predict either 30-day readmissions or 30-day costs outcomes given intervention status and the presence of other demographic and admit-related factors including age, gender, race, admission diagnosis, whether the admission was for a surgery, Medicare enrollment status (aged, ESRD, etc.), marital status, disease burden, previous healthcare usage, admission disease severity, clinically assessed acuity, and the length of the hospital stay. The intervention was defined as enrollment in the care pathway and at least two patient-directed activities (such as bedside visits and phone calls to the patient). RESULTS : After controlling for other factors, there was a mean 16% reduction in the likelihood of readmission (95% credible interval: 36% reduction to 3% increase), and a mean cost savings of $2585 per patient (95% credible interval: $5640 cost savings to $520 cost increase per patient), driven by a large savings in inpatient spending offsetting small increases in other claim types. For the readmissions model, strong admission disease:treatment interaction effects were observed. CONCLUSIONS : The inpatient care transitions program most likely reduces readmissions in this population, with heterogeneous effects depending on the disease leading to admission. It also likely decreases overall patient costs by preventing costly inpatient stays.
Conference/Value in Health Info
2020-05, ISPOR 2020, Orlando, FL, USA
Value in Health, Volume 23, Issue 5, S1 (May 2020)
Code
PMU8
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Methodological & Statistical Research
Topic Subcategory
Clinical Outcomes Assessment, Confounding, Selection Bias Correction, Causal Inference, Disease Management, Performance-based Outcomes
Disease
Multiple Diseases