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National Trends in Readmission Following Inpatient Surgery in the Hospital Readmissions Reduction Program Era.

Abstract：

OBJECTIVE:The aim of this study was to investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a "spillover" effect on surgical conditions. SUMMARY BACKGROUND DATA:During the past decade, there have been multiple national efforts to improve surgical care. Readmission rates are a key metric for assessing surgical quality. Whether surgical readmission rates have declined, and whether the Hospital Readmissions Reduction Program has had an influence is unclear. METHODS:Using national Medicare data, we identified patients undergoing a range of procedures during the past decade. We examined whether certain procedures that would be targeted by the HRRP had a differential change in readmissions compared to other procedures. We used an interrupted time-series model to examine readmission trends in three time periods: pre-ACA, HRRP implementation, and HRRP penalty. RESULTS:Between 2005 and 2014, 17,423,106 patients underwent the procedures of interest; risk-adjusted rates of readmission across the 8 procedures declined from 12.2% to 8.6%. Pre-ACA rates of readmission were decreasing [-0.060% per quarter (-0.072%, -0.048%), P < 0.001]. During the HRRP implementation period, the rate of decline of readmissions increased [-0.129% (-0.142%, -0.116%), P < 0.001] and continued declining at a similar rate during the penalty period [-0.118% (-0.131%, -0.105%), P < 0.001]. Largest declines in surgical readmissions were seen among the nontargeted procedures. The hospitals with the greatest reductions in medical readmissions also had the greatest drop in surgical readmissions. CONCLUSIONS:Surgical readmission rates have fallen during the past decade and rates of decline have increased during the HRRP period.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Mehtsun WT,Papanicolas I,Zheng J,Orav EJ,Lillemoe KD,Jha AK

doi

10.1097/SLA.0000000000002350

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

599-605

issue

eissn

0003-4932

issn

1528-1140

journal_volume

267

pub_type

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National Trends in Readmission Following Inpatient Surgery in the Hospital Readmissions Reduction Program Era.