| Related Articles |
Variation in readmission rates by emergency departments and emergency department providers caring for patients after discharge.
J Hosp Med. 2015 Jun 30;
Authors: Singh S, Lin YL, Nattinger AB, Kuo YF, Goodwin JS
Abstract
BACKGROUND: The role of the emergency department (ED) provider and ED facility in readmissions of recently discharged patients who visit the ED has not been studied.
OBJECTIVE: To determine the variation in readmission rates by ED facility and ED providers caring for patients after discharge.
DESIGN: Retrospective cohort study using multilevel, multivariable models of 100% Texas Medicare claims data from the years 2007 to 2011.
SETTING: Texas acute-care hospitals and ED facilities.
PATIENTS: Medicare beneficiaries who visited an ED within 30 days of discharge from a hospital.
INTERVENTION: None.
MEASUREMENT: Readmission after an ED visit within 30 days of discharge from an initial hospitalization defined as a hospitalization starting the day of or the day following the ED visit.
RESULTS: The mean readmission rate following an ED visit was 52.67%. In 2-level models, 14.2% of ED providers readmitted significantly more patients (mean readmission rate of 67.2%) than the mean; 14.7% of ED providers readmitted significantly fewer patients (mean readmission rate of 36.8%) than the mean. After accounting for the ED facility in 3-level models, the variance for the ED providers decreased 65% from 0.2532 to 0.0893.
CONCLUSIONS: The risk of readmission varies by ED provider caring for patients after discharge. A large part of this variation is explained by the ED facility in which the ED providers practice. Thus, ED provider practices patterns and ED facility systems of care may be a target for interventions to reduce readmissions. Journal of Hospital Medicine 2015. © 2015 Society of Hospital Medicine.
PMID: 26130443 [PubMed - as supplied by publisher]