The Effect of the Hospital Readmission Reduction Program on the Duration of Observation Stays: Using Regression Discontinuity to Estimate Causal Effects.

Jordan Albritton, Thomas Belnap, Lucy Savitz
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引用次数: 5

Abstract

Research objective: Determine whether hospitals are increasing the duration of observation stays following index admission for heart failure to avoid potential payment penalties from the Hospital Readmission Reduction Program.

Study design: The Hospital Readmission Reduction Program applies a 30-day cutoff after which readmissions are no longer penalized. Given this seemingly arbitrary cutoff, we use regression discontinuity design, a quasi-experimental research design that can be used to make causal inferences.

Population studied: The High Value Healthcare Collaborative includes member healthcare systems covering 57% of the nation's hospital referral regions. We used Medicare claims data including all patients residing within these regions. The study included patients with index admissions for heart failure from January 1, 2012 to June 30, 2015 and a subsequent observation stay within 60 days. We excluded hospitals with fewer than 25 heart failure readmissions in a year or fewer than 5 observation stays in a year and patients with subsequent observation stays at a different hospital.

Principal findings: Overall, there was no discontinuity at the 30-day cutoff in the duration of observation stays, the percent of observation stays over 12 hours, or the percent of observation stays over 24 hours. In the sub-analysis, the discontinuity was significant for non-penalized.

Conclusion: The findings reveal evidence that the HRRP has resulted in an increase in the duration of observation stays for some non-penalized hospitals.

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减少再入院计划对观察住院时间的影响:使用回归不连续来估计因果效应。
研究目的:确定医院是否增加心力衰竭指数入院后的观察时间,以避免医院再入院减少计划的潜在付款处罚。研究设计:医院再入院减少计划采用30天的截止日期,之后再入院不再受到处罚。考虑到这个看似任意的截止点,我们使用回归不连续设计,这是一种准实验研究设计,可用于进行因果推断。人口研究:高价值医疗保健协作包括成员医疗保健系统覆盖全国57%的医院转诊地区。我们使用的医疗保险索赔数据包括居住在这些地区的所有患者。该研究纳入了2012年1月1日至2015年6月30日因心力衰竭入院的患者,并在随后的60天内观察住院。我们排除了一年内心力衰竭再入院少于25次或一年内观察住院少于5次的医院以及随后在不同医院观察的患者。主要发现:总体而言,在观察停留时间的30天截止时间内,观察停留时间超过12小时的百分比或观察停留时间超过24小时的百分比没有间断。在子分析中,非处罚组的不连续性显著。结论:调查结果显示,HRRP导致一些未受处罚医院的观察住院时间增加。
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