title: Pneumonia rehospitalization of the Medicare fee-for-service patient: a state-level analysis: exploring 30-day readmission factors.
abstract: OBJECTIVE
  Pneumonia hospitalization and subsequent readmission among the elderly are frequent and costly both to patient and to the Medicare trust fund. In this study, we explored the factors that are associated with states having pneumonia readmission rates that are higher than the U.S. national rate.
  
  
  METHODS
  Acute inpatient hospital settings.
  
  
  METHODS
  Fifty state-level data and multivariate regression analysis were used. The dependent variable pneumonia 30-day readmission worse than U.S. rate was based on adult Medicare fee-for-service patients hospitalized with a primary discharge diagnosis of pneumonia and for which a subsequent inpatient readmission occurred within 30 days of their last discharge.
  
  
  RESULTS
  Two key variables--discharge information given to the patient and giving correct initial antibiotic(s)--explain a decreased chance for states ranking "worse" on pneumonia 30-day readmission. States with a higher percentage of White Medicare enrollees, a higher median income, more total days of care, and more Medicare enrollees with prescription drug coverage have a greater chance for pneumonia 30-day readmission to be worse than the U.S. national rate.
  
  
  CONCLUSIONS
  Case management interventions targeting (1) inpatient clinical processes on antibiotic treatment and (2) patient discharge instructions may be more effective than other factors to improve state-level hospital performance on pneumonia 30-day readmission. Improving patient access to postdischarge medication(s) may not be as important a factor as are antibiotic treatment and patient discharge preparedness. Hospital programs aimed to prevent readmission disparities should not overlook nonminority and higher income population groups.
authors.affiliation: Kent State University, Kent, OH 44224, USA. mschmeid@kent.edu
authors.forename: Mary
authors.initials: M
authors.lastname: Schmeida
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Savrin
mesh_terms: D019090:Case Management / Q000191:economics / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009820:Ohio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000191:economics / Q000628:therapy*; D012307:Risk Factors; D014481:United States