title: Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time.
abstract: Programs from the Centers for Medicare and Medicaid Services simultaneously promote strategies to lower hospital admissions and readmissions. However, there is concern that hospitals in communities that successfully reduce admissions may be penalized, as patients that are ultimately hospitalized may be sicker and at higher risk of readmission. We therefore examined the relationship between changes from 2010 to 2013 in admission rates and thirty-day readmission rates for elderly Medicare beneficiaries. We found that communities with the greatest decline in admission rates also had the greatest decline in thirty-day readmission rates, even though hospitalized patients did grow sicker as admission rates declined. The relationship between changing admission and readmission rates persisted in models that measured observed readmission rates, risk-standardized readmission rates, and the combined rate of readmission and death. Our findings suggest that communities can reduce admission rates and readmission rates in parallel, and that federal policy incentivizing reductions in both outcomes does not create contradictory incentives.
authors.affiliation: Kumar Dharmarajan (kumar.dharmarajan@yale.edu) is an assistant professor of medicine at the Yale University School of Medicine, in New Haven, Connecticut.
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
authors.affiliation: Li Qin is an associate research scientist in medicine at the Yale University School of Medicine.
authors.forename: Li
authors.initials: L
authors.lastname: Qin
authors.affiliation: Zhenqiu Lin is director of analytics at the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital.
authors.forename: Zhenqiu
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Leora I. Horwitz is an associate professor at the New York University School of Medicine, in New York City.
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.affiliation: Joseph S. Ross is an associate professor of medicine at the Yale University School of Medicine.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.affiliation: Elizabeth E. Drye is director of quality measurement programs at the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Drye
authors.affiliation: Amena Keshawarz is a doctoral candidate in epidemiology at the University of Colorado, Anschutz Medical Campus, in Aurora. At the time this research was performed, she was a research project coordinator at the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital.
authors.forename: Amena
authors.initials: A
authors.lastname: Keshawarz
authors.affiliation: Faseeha Altaf is a research project coordinator at the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital.
authors.forename: Faseeha
authors.initials: F
authors.lastname: Altaf
authors.affiliation: Sharon-Lise T. Normand is a professor of health care policy (biostatistics) at Harvard Medical School and a professor of biostatistics at the Harvard T. H. Chan School of Public Health, both in Boston, Massachusetts.
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.affiliation: Harlan M. Krumholz is the Harold H. Hines Jr. Professor of Medicine and Epidemiology and Public Health at the Yale University School of Medicine.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: Susannah M. Bernheim is director of quality measurement programs at the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital.
authors.forename: Susannah M
authors.initials: SM
authors.lastname: Bernheim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States
keywords: Epidemiology; Health Promotion/Disease Prevention; Hospitals; Medicare; Quality Of Care