The relative effects of patient and hospital factors on postpartum readmissions

被引:26
作者
Clapp, Mark A. [1 ]
Little, Sarah E. [2 ]
Zheng, Jie [3 ]
Robinson, Julian N. [2 ]
Kaimal, Anjali J. [1 ]
机构
[1] Massachusetts Gen Hosp, Dept Obstet & Gynecol, Boston, MA 02114 USA
[2] Brigham & Womens Hosp, Dept Obstet & Gynecol, 75 Francis St, Boston, MA 02115 USA
[3] Harvard Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA
关键词
QUALITY-OF-CARE; CESAREAN DELIVERY; REDUCTION PROGRAM; RATES; RACE;
D O I
10.1038/s41372-018-0125-8
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective To determine the relative effects of patient and hospital factors on a hospital's postpartum readmission rate. Study design This retrospective cohort study was conducted using State Inpatient Databases from California, Florida, and New York between 2004 and 2013. We compared patient and hospital characteristics among hospitals with low and high readmission rates using chi(2) tests. Risk-adjusted 30-day readmission rates were calculated for patient, delivery, and hospital characteristics to understand factors affecting readmission using fixed and random effects models. Results Patients in hospitals with low readmission rates were more likely to be white, to have private insurance and higher incomes, and to have fewer comorbidities. The patient comorbidities with the highest risk-adjusted readmission rates included hypertension (range, 2.14-3.04%), obesity (1.78-2.94%), preterm labor/delivery (2.50-2.60%), and seizure disorder (1.78-3.35%). Delivery complications were associated with increased risk-adjusted readmission rates. Compared to patient characteristics, hospital characteristics did not have a profound impact on readmission risk. Conclusion Obstetric readmissions were more attributable to patient and demographic characteristics than to hospital characteristics. Readmission metric-based incentives may ultimately penalize hospitals providing high-quality care due to patient characteristics specific to their catchment area.
引用
收藏
页码:804 / 812
页数:9
相关论文
共 19 条
[1]  
[Anonymous], 2016, AM J OBSTET GYNECOL
[2]   Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures [J].
Armstrong, Joanne C. ;
Kozhimannil, Katy B. ;
McDermott, Patricia ;
Saade, George R. ;
Srinivas, Sindhu K. .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2016, 214 (02) :153-163
[3]   Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients [J].
Auerbach, Andrew D. ;
Kripalani, Sunil ;
Vasilevskis, Eduard E. ;
Sehgal, Neil ;
Lindenauer, Peter K. ;
Metlay, Joshua P. ;
Fletcher, Grant ;
Ruhnke, Gregory W. ;
Flanders, Scott A. ;
Kim, Christopher ;
Williams, Mark V. ;
Thomas, Larissa ;
Giang, Vernon ;
Herzig, Shoshana J. ;
Patel, Kanan ;
Boscardin, W. John ;
Robinson, Edmondo J. ;
Schnipper, Jeffrey L. .
JAMA INTERNAL MEDICINE, 2016, 176 (04) :484-493
[4]   Society for Maternal-Fetal Medicine (SMFM) Special Report: Current approaches to measuring quality of care in obstetrics [J].
Bailit, Jennifer L. ;
Gregory, Kimberly D. ;
Srinivas, Sindhu ;
Westover, Thomas ;
Grobman, William A. ;
Saade, George R. .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2016, 215 (03) :B8-B16
[5]  
Centers for Medicare and Medicaid Services, 2016, READM RED PROGR
[6]   Hospital-Level Variation in Postpartum Readmissions [J].
Clapp, Mark A. ;
Little, Sarah E. ;
Zheng, Jie ;
Kaimal, Anjali J. ;
Robinson, Julian N. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2017, 317 (20) :2128-2129
[7]   Does the increasing cesarean delivery rate explain the increasing rate of postpartum readmissions? [J].
Clapp, Mark A. ;
Robinson, Julian N. ;
Bortoletto, Pietro ;
Little, Sarah E. .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2016, 214 (01) :S130-S130
[8]   The Relationship between Hospital Admission Rates and Rehospitalizations [J].
Epstein, Arnold M. ;
Jha, Ashish K. ;
Orav, E. John .
NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (24) :2287-2295
[9]  
Healthcare Cost and Utilization Project, 2012, HCUP METH SER OV KEY
[10]   Public Reporting of Discharge Planning and Rates of Readmissions [J].
Jha, Ashish K. ;
Orav, E. John ;
Epstein, Arnold M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (27) :2637-2645