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Changes in Hospital Referral Patterns to Skilled Nursing Facilities Under the Hospital Readmissions Reduction Program

机译：医院转诊模式对医院阅览室减少熟练的护理设施的变化

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摘要

Background: The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for higher-than-expected readmission rates. Almost 20% of Medicare fee-for-service (FFS) patients receive postacute care in skilled nursing facilities (SNFs) after hospitalization. SNF patients have high readmission rates. Objective: The objective of this study was to investigate the association between changes in hospital referral patterns to SNFs and HRRP penalty pressure. Design: We examined changes in the relationship between penalty pressure and outcomes before versus after HRRP announcement among 2698 hospitals serving 6,936,393 Medicare FFS patients admitted for target conditions: acute myocardial infarction, heart failure, or pneumonia. Hospital-level penalty pressure was the expected penalty rate in the first year of the HRRP multiplied by Medicare discharge share. Outcomes: Informal integration measured by the percentage of referrals to hospitals' most referred SNF; formal integration measured by SNF acquisition; readmission-based quality index of the SNFs to which a hospital referred discharged patients; referral rate to any SNF. Results: Hospitals facing the median level of penalty pressure had modest differential increases of 0.3 percentage points in the proportion of referrals to the most referred SNF and a 0.006 SD increase in the average quality index of SNFs referred to. There were no statistically significant differential increases in formal acquisition of SNFs or referral rate to SNF. Conclusions: HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNF differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
机译：背景：医院入院减少计划（HRRP）惩罚医院的入院率高于预期。近20％的医疗保险服务费（FFS）患者在住院后接受熟练的护理设施（SNF）的前休息护理。 SNF患者的入院率很高。目的：本研究的目的是调查医院转诊模式的变化与SNF和HRRP罚款压力之间的关联。设计：在HRRP公告之前，在2698家医院接受靶向条件的2698家医院患者之间的惩罚压力和结果之间的关系审查了变化：急性心肌梗死，心力衰竭或肺炎。医院级别的惩罚压力是HRRP第一年的预期罚款率乘以医疗保险分配份额。结果：非正式的一体化，通过向医院的推荐百分比来衡量;通过SNF收购来衡量的正式整合;医院提到患者的SNF的基于入院的质量指数;转诊率与任何SNF。结果：面临中位数罚款压力水平的医院具有适度的差异增加0.3个百分点，从而为最多引用的SNF比例的比例和SNF的平均质量指数的0.006 SD增加。正式收购SNF或转诊率与SNF的统计上没有统计学显着的差异。结论：HRRP对SNF的医院转诊模式没有迅速发生大量变化，尽管对SNF的患者的阅必性量比其他患者差异降低，需要调查其他机制的依据减少。

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  • 来源
    《Medical care》 |2019年第9期|共7页
  • 作者

    Kim K. Lucy; Li Li; Kuang Meng; Horwitz Leora I.; Desai Sunita M.;

  • 作者单位

    NYU Sch Med Dept Populat Hlth Div Healthcare Delivery Sci New York NY USA;

    Yale New Haven Med Ctr Ctr Outcomes Res &

    Evaluat 20 York St New Haven CT 06504 USA;

    Yale New Haven Med Ctr Ctr Outcomes Res &

    Evaluat 20 York St New Haven CT 06504 USA;

    NYU Sch Med Dept Populat Hlth Div Healthcare Delivery Sci New York NY USA;

    NYU Sch Med Dept Populat Hlth Div Healthcare Delivery Sci New York NY USA;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 护理学;
  • 关键词

    health policy; economics; quality; readmissions;

    机译：健康政策;经济学;质量;再生;

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