Journal article
Risk-Standardized Home Time as a Novel Hospital Performance Metric for Pneumonia Hospitalization Among Medicare Beneficiaries: a Retrospective Cohort Study
Journal of general internal medicine : JGIM, Vol.36(10), pp.3031-3039
04/26/2021
DOI: 10.1007/s11606-021-06712-w
PMCID: PMC8481448
PMID: 33904043
Abstract
The Centers for Medicare & Medicaid Services (CMS) use hospital readmissions as a performance metric to incentivize hospital care for acute conditions including pneumonia. However, there are limitations to using readmission alone as a hospital performance metric.
To characterize 30-day risk-standardized home time (RSHT), a novel patient-centered post-discharge performance metric for acute pneumonia hospitalizations in Medicare patients, and compare hospital rankings based on this metric with mortality and readmissions.
Retrospective, cohort study.
A cohort of Medicare fee-for-service beneficiaries admitted between January 01, 2015 and November 30, 2017.
None.
Risk-standardized hospital-level home time within 30 days of discharge was evaluated as a novel performance metric. Multilevel regression models were used to calculate hospital-level estimates and rank hospitals based on RSHT, readmission rate (RSRR), and mortality rate (RSMR).
A total of 1.7 million pneumonia admissions admitted to one of the 3116 hospitals were eligible for inclusion. The median 30-day RSHT was 20.5 days (interquartile range: 18.9-21.9 days; range: 5-29 days). Hospital-level characteristics such as case volume, bed size, for-profit ownership, rural location of the hospital, teaching status, and participation in the bundled payment program were significantly associated with home time. We found a modest, inverse correlation of RSHT with RSRR (rho: -0.233, p< 0.0001) and RSMR (rho: -0.223, p< 0.0001) for pneumonia. About 1/3rd of hospitals were reclassified as high performers based on their RSHT metric compared with the rank on their RSRR and RSMR metrics.
Home time is a novel, patient-centered, hospital-level metric that can be easily calculated using claims data and accounts for mortality, readmission to an acute care facility, and admission to a skilled nursing facility or long-term care facility after discharge. Utilization of this patient-centered metric could have policy implications in assessing hospital performance on delivery of healthcare to pneumonia patients.
Details
- Title: Subtitle
- Risk-Standardized Home Time as a Novel Hospital Performance Metric for Pneumonia Hospitalization Among Medicare Beneficiaries: a Retrospective Cohort Study
- Creators
- Rajeshwari Nair - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IA, USAYubo Gao - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IA, USAMary S Vaughan-Sarrazin - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IA, USAEli Perencevich - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IA, USASaket Girotra - Division of Cardiovascular Diseases, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USAAmbarish Pandey - Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. ambarish.pandey@utsouthwestern.edu
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.36(10), pp.3031-3039
- DOI
- 10.1007/s11606-021-06712-w
- PMID
- 33904043
- PMCID
- PMC8481448
- NLM abbreviation
- J Gen Intern Med
- eISSN
- 1525-1497
- Publisher
- United States
- Grant note
- R01-AG055663 / NIA NIH HHS
- Language
- English
- Date published
- 04/26/2021
- Academic Unit
- Health Management and Policy; Epidemiology; Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984077376002771
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