Graduation Date

Fall 12-18-2020

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Health Services Research, Administration, and Policy

First Advisor

Li-Wu Chen

Abstract

The Hospital Readmission Reduction Program (HRRP), a part of the Affordable Care Act (ACA), requires the Centers for Medicare and Medicaid Services (CMS) to penalize hospitals with excess readmissions. The following conditions/procedures with high 30-day readmission rates were included in the program: Acute Myocardial Infarction, heart failure, pneumonia, chronic obstructive pulmonary disease, total hip arthroplasty and/or total knee arthroplasty, and coronary artery bypass graft (CABG). More research needs to be done regarding the national impact of the program. In addition, the risk factors of newly targeted CABG needs to be investigated robustly. Lastly, besides evaluating the risk of readmissions before the discharge, our study explored the advantages of the continuity of the care after the discharge.

This dissertation comprised three independent studies of hospital readmissions under the HRRP, including (1) evaluation of the national impact and spill-over effect of the HRRP; (2) identification of the predictors of cause-specific readmissions after CABG; and (3) comparison of health outcomes and health care utilizations between readmission to a same vs different hospital.

The Nationwide Readmissions Database 2010-2016 were used. The first study suggested the positive impact of the HRRP on Medicare target readmissions and modest spill-over effect on Private-insured and non-target readmissions. The second study explored the predictors for cause-specific readmissions following CABG, which revealed the significance of comorbidity in predicting cause-specific readmissions. The third study demonstrated that readmissions to different hospitals were associated with worse health outcomes and greater health care utilizations, which highlighted the importance of the continuity of care.

In conclusion, the HRRP impacted hospital readmissions in an intended way. By investigating the predictors of readmission for CABG, a newly targeted procedure under the HRRP, we found that predictors for readmission varied if the readmission causes were different. Before the discharge, early identification of patients at high risk can help reduce preventable readmissions. After discharge, improving care coordination and enhancing the information exchange could help achieve continuity of the care, attain better health outcomes, and utilize fewer health resources.

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