MedicalResearch.com Interview with:
Kumar Dharmarajan, MD, MBA
Assistant Professor of Medicine (Cardiology)
Cardiovascular Medicine: Center for Outcomes Research & Evaluation (CORE)
Yale School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: 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.
MedicalResearch.com: What should readers take away from your report?
Response: 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. Doing the right thing for the patient in one setting seems to help in others as well.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We need to better understand what specific strategies help concurrently improve admissions and readmissions. Are some better than others? What are the most cost effective interventions that can be most easily disseminated and adapted to local contexts?
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time
Kumar Dharmarajan, Li Qin, Zhenqiu Lin, Leora I. Horwitz, Joseph S. Ross,Elizabeth E. Drye, Amena Keshawarz, Faseeha Altaf, Sharon-Lise T. Normand,Harlan M. Krumholz, and Susannah M. Bernheim
Health Aff July 2016 35:71294-1302; doi:10.1377/hlthaff.2015.1614
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