Variation in the risk of readmission among hospitals: the relative contribution of patient, hospital and inpatient provider characteristics. J Gen Intern Med 2014 Apr;29(4):572-8
Date
12/07/2013Pubmed ID
24307260Pubmed Central ID
PMC3965757DOI
10.1007/s11606-013-2723-7Scopus ID
2-s2.0-84898596925 (requires institutional sign-in at Scopus site) 68 CitationsAbstract
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.
Author List
Singh S, Lin YL, Kuo YF, Nattinger AB, Goodwin JSAuthor
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Clinical Competence
Cohort Studies
Female
Hospitals
Humans
Inpatients
Male
Medicare
Patient Participation
Patient Readmission
Retrospective Studies
Risk Factors
Texas
United States
