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Post-Discharge Services for Different Diagnoses Than Index Hospitalization Predict Decreased 30-Day Readmissions Among Medicare Beneficiaries

Abstract

Background

Efforts to reduce hospital readmissions include post-discharge interventions related to the illness treated during the index hospitalization (IH). These efforts may be inadequate because readmissions are precipitated by a wide range of health conditions unrelated to the primary diagnosis of the IH.

Objective

To investigate the relationship between post-discharge health services utilization for the same or a different diagnosis than the IH and unplanned 30-day readmission.

Design and Participants

The study sample included 583,199 all-cause IHs among 2014 Medicare fee-for-service beneficiaries. For all-cause IH, as well as individually for heart failure, myocardial infarction, and pneumonia IH, we used multivariable logistic regressions to investigate the association between post-discharge services utilization and readmission.

Main Measures

The outcome was unplanned 30-day readmission. Primary independent variables were post-discharge services utilization, including institutional outpatient, office-based primary care, office-based specialist, office-based non-physician practitioner, emergency department, home health care, and skilled nursing facility providers.

Key Results

Among all-cause IH, 11.7% resulted in unplanned 30-day readmissions, and only 18.1% of readmissions occurred for the same primary diagnosis as IH. A substantial majority of post-discharge health services were utilized for a primary diagnosis differing from IH. Compared with no visit, institutional outpatient visits for the same primary diagnosis as IH (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.31–0.34) and for a different primary diagnosis than IH (OR, 0.36; 95% CI, 0.35–0.37) were similarly strongly associated with decreased unplanned 30-day readmission. Primary care physician, specialist, non-physician practitioner, and home health care showed similar patterns. IH for heart failure, myocardial infarction, and pneumonia manifested similar patterns to all-cause IH both in terms of post-discharge services utilization and in terms of its impact on readmission.

Conclusions

To reduce unplanned 30-day readmission more effectively, discharge planning should include post-discharge services to address health conditions beyond the primary cause of the IH.

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Author information

Dr. Tak had full access to all of the data in the study and takes the responsibility for the integrity of the data and the accuracy of the data analysis. All authors have made substantial contributions to this manuscript and attest to the validity and legitimacy of the data as well as its interpretation. We do not have any other contributors who were not listed in the authors.

Correspondence to Hyo Jung Tak PhD.

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Compliance with Ethical Standards

The University of Nebraska Medical Center Institutional Review Board approved this study.

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The authors declare that they do not have a conflict of interest.

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Tak, H.J., Chen, L., Wilson, F.A. et al. Post-Discharge Services for Different Diagnoses Than Index Hospitalization Predict Decreased 30-Day Readmissions Among Medicare Beneficiaries. J GEN INTERN MED 34, 1766–1774 (2019). https://doi.org/10.1007/s11606-019-05115-2

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KEY WORDS

  • all-cause index hospitalization
  • 30-day readmission
  • post-discharge services utilization
  • service diagnosis
  • Hospital Readmission Reduction Program