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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 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.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Singh S,Lin YL,Kuo YF,Nattinger AB,Goodwin JS

doi

10.1007/s11606-013-2723-7

subject

Has Abstract

pub_date

2014-04-01 00:00:00

pages

572-8

issue

eissn

0884-8734

issn

1525-1497

journal_volume

pub_type

杂志文章,多中心研究

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Variation in the risk of readmission among hospitals: the relative contribution of patient, hospital and inpatient provider characteristics.