%0 Journal Article
%T Effect of Hospital Readmission Reduction on Patients at Low, Medium, and High Risk of Readmission in the Medicare Population
%A Jacqueline N. Grady
%A MS
%A Jeph Herrin
%A PhD
%A Ji Young Kwon
%A MPH
%A Leora I. Horwitz
%A MD
%A MHS
%A Saul Blecker
%A MD
%A MHS
%A Simon Jones
%A PhD
%J Journal of Hospital Medicine
%D 2018
%R 10.12788/jhm.2936
%X BACKGROUND: Hospitalization and readmission rates have decreased in recent years, with the possible consequence that hospitals are increasingly filled with high-risk patients.OBJECTIVE: We studied whether readmission reduction has affected the risk profile of hospitalized patients and whether readmission reduction was similarly realized among hospitalizations with low, medium, and high risk of readmissions.DESIGN: Retrospective study of hospitalizations between January 2009 and June 2015.PATIENTS: Hospitalized fee-for-service Medicare beneficiaries, categorized into 1 of 5 specialty cohorts used for the publicly reported hospital-wide readmission measure.MEASUREMENTS: Each hospitalization was assigned a predicted risk of 30-day, unplanned readmission using a risk-adjusted model similar to publicly reported measures. Trends in monthly mean predicted risk for each cohort and trends in monthly observed to expected readmission for hospitalizations in the lowest 20%, middle 60%, and highest 20% of risk of readmission were assessed using time series models.RESULTS: Of 47,288,961 hospitalizations, 16.2% (n = 7,642,161) were followed by an unplanned readmission within 30 days. We found that predicted risk of readmission increased by 0.24% (P = .03) and 0.13% (P = .004) per year for hospitalizations in the surgery/gynecology and neurology cohorts, respectively. We found no significant increase in predicted risk for hospitalizations in the medicine (0.12%, P = .12), cardiovascular (0.32%, P = .07), or cardiorespiratory (0.03%, P = .55) cohorts. In each cohort, observed to expected readmission rates steadily declined, and at similar rates for patients at low, medium, and high risk of readmission.CONCLUSIONS: Hospitals have been effective at reducing readmissions across a range of patient risk strata and clinical conditions. The risk of readmission for hospitalized patients has increased for 2 of 5 clinical cohorts
%U https://www.journalofhospitalmedicine.com/jhospmed/article/157582/hospital-medicine/effect-hospital-readmission-reduction-patients-low-medium