title: Variation in readmission rates by emergency departments and emergency department providers caring for patients after discharge.
abstract: BACKGROUND
  The role of the emergency department (ED) provider and ED facility in readmissions of recently discharged patients who visit the ED has not been studied.
  
  
  OBJECTIVE
  To determine the variation in readmission rates by ED facility and ED providers caring for patients after discharge.
  
  
  METHODS
  Retrospective cohort study using multilevel, multivariable models of 100% Texas Medicare claims data from the years 2007 to 2011.
  
  
  METHODS
  Texas acute-care hospitals and ED facilities.
  
  
  METHODS
  Medicare beneficiaries who visited an ED within 30 days of discharge from a hospital.
  
  
  METHODS
  None.
  
  
  METHODS
  Readmission after an ED visit within 30 days of discharge from an initial hospitalization defined as a hospitalization starting the day of or the day following the ED visit.
  
  
  RESULTS
  The mean readmission rate following an ED visit was 52.67%. In 2-level models, 14.2% of ED providers readmitted significantly more patients (mean readmission rate of 67.2%) than the mean; 14.7% of ED providers readmitted significantly fewer patients (mean readmission rate of 36.8%) than the mean. After accounting for the ED facility in 3-level models, the variance for the ED providers decreased 65% from 0.2532 to 0.0893.
  
  
  CONCLUSIONS
  The risk of readmission varies by ED provider caring for patients after discharge. A large part of this variation is explained by the ED facility in which the ED providers practice. Thus, ED provider practices patterns and ED facility systems of care may be a target for interventions to reduce readmissions.
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin.|Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Lin
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin.|Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
authors.affiliation: Department of Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.affiliation: Department of Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D014481:United States; D000078329:Workforce