Community Factors and Hospital Readmission Rates

Overview

Journal Health Serv Res

Specialty Health Services

Date 2014 Apr 10

PMID 24712374

Citations 92

Authors

Jeph Herrin

Justin St Andre

Kevin Kenward

Maulik S Joshi

Anne-Marie J Audet

Stephen C Hines

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the relationship between community factors and hospital readmission rates.

Data Sources/study Setting: We examined all hospitals with publicly reported 30-day readmission rates for patients discharged during July 1, 2007, to June 30, 2010, with acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN). We linked these to publicly available county data from the Area Resource File, the Census, Nursing Home Compare, and the Neilsen PopFacts datasets.

Study Design: We used hierarchical linear models to assess the effect of county demographic, access to care, and nursing home quality characteristics on the pooled 30-day risk-standardized readmission rate.

Data Collection/extraction Methods: Not applicable.

Principal Findings: The study sample included 4,073 hospitals. Fifty-eight percent of national variation in hospital readmission rates was explained by the county in which the hospital was located. In multivariable analysis, a number of county characteristics were found to be independently associated with higher readmission rates, the strongest associations being for measures of access to care. These county characteristics explained almost half of the total variation across counties.

Conclusions: Community factors, as measured by county characteristics, explain a substantial amount of variation in hospital readmission rates.

Citing Articles

Machine learning based predictive modeling of readmissions following extracorporeal membrane oxygenation hospitalizations.

Balian J, Sakowitz S, Verma A, Vadlakonda A, Cruz E, Ali K Surg Open Sci. 2024; 19:125-130.

PMID: 38655069 PMC: 11035075. DOI: 10.1016/j.sopen.2024.04.003.

The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review.

Bammert P, Schuttig W, Novelli A, Iashchenko I, Spallek J, Blume M Int J Equity Health. 2024; 23(1):37.

PMID: 38395914 PMC: 10885500. DOI: 10.1186/s12939-024-02122-6.

Association of hospital and market characteristics with 30-day readmission rates from 2009 to 2015.

Tajeu G, Davlyatov G, Becker D, Weech-Maldonado R, Kazley A SAGE Open Med. 2024; 12:20503121231220815.

PMID: 38249949 PMC: 10798130. DOI: 10.1177/20503121231220815.

Measuring Equity in Readmission as a Distinct Assessment of Hospital Performance.

Nash K, Weerahandi H, Yu H, Venkatesh A, Holaday L, Herrin J JAMA. 2024; 331(2):111-123.

PMID: 38193960 PMC: 10777266. DOI: 10.1001/jama.2023.24874.

Differential impact of hospital and community factors on breadth and depth of hospital population health partnerships.

Puro N, Cronin C, Franz B, Singh S, Feyereisen S Health Serv Res. 2023; 59 Suppl 1:e14238.

PMID: 37727122 PMC: 10796292. DOI: 10.1111/1475-6773.14238.

References

Bradley E, Curry L, Spatz E, Herrin J, Cherlin E, Curtis J . Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. Ann Intern Med. 2012; 156(9):618-26. PMC: 3386642. DOI: 10.7326/0003-4819-156-9-201205010-00003. View

Bradley E, Herrin J, Curry L, Cherlin E, Wang Y, Webster T . Variation in hospital mortality rates for patients with acute myocardial infarction. Am J Cardiol. 2010; 106(8):1108-12. DOI: 10.1016/j.amjcard.2010.06.014. View

Krumholz H, Merrill A, Schone E, Schreiner G, Chen J, Bradley E . Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes. 2009; 2(5):407-13. DOI: 10.1161/CIRCOUTCOMES.109.883256. View

Ingram D, Franco S . NCHS urban-rural classification scheme for counties. Vital Health Stat 2. 2012; (154):1-65. View

Chen J, Ross J, Carlson M, Lin Z, Normand S, Bernheim S . Skilled nursing facility referral and hospital readmission rates after heart failure or myocardial infarction. Am J Med. 2011; 125(1):100.e1-9. PMC: 3246370. DOI: 10.1016/j.amjmed.2011.06.011. View

Jasti H, Mortensen E, Obrosky D, Kapoor W, Fine M . Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis. 2008; 46(4):550-6. DOI: 10.1086/526526. View

Foraker R, Rose K, Suchindran C, Chang P, McNeill A, Rosamond W . Socioeconomic status, Medicaid coverage, clinical comorbidity, and rehospitalization or death after an incident heart failure hospitalization: Atherosclerosis Risk in Communities cohort (1987 to 2004). Circ Heart Fail. 2011; 4(3):308-16. PMC: 3098576. DOI: 10.1161/CIRCHEARTFAILURE.110.959031. View

Soobader M, LeClere F, Hadden W, Maury B . Using aggregate geographic data to proxy individual socioeconomic status: does size matter?. Am J Public Health. 2001; 91(4):632-6. PMC: 1446644. DOI: 10.2105/ajph.91.4.632. View

Axon R, Williams M . Hospital readmission as an accountability measure. JAMA. 2011; 305(5):504-5. DOI: 10.1001/jama.2011.72. View

10.

Howie-Esquivel J, Spicer J . Association of partner status and disposition with rehospitalization in heart failure patients. Am J Crit Care. 2012; 21(3):e65-73. DOI: 10.4037/ajcc2012382. View

11.

Hannan E, Racz M, Walford G, Ryan T, Isom O, Bennett E . Predictors of readmission for complications of coronary artery bypass graft surgery. JAMA. 2003; 290(6):773-80. DOI: 10.1001/jama.290.6.773. View

12.

Joynt K, Jha A . Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives. Circ Cardiovasc Qual Outcomes. 2010; 4(1):53-9. PMC: 3050549. DOI: 10.1161/CIRCOUTCOMES.110.950964. View

13.

Marcantonio E, McKean S, Goldfinger M, Kleefield S, Yurkofsky M, Brennan T . Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. Am J Med. 1999; 107(1):13-7. DOI: 10.1016/s0002-9343(99)00159-x. View

14.

Murphy B, Elliott P, Le Grande M, Higgins R, Ernest C, Goble A . Living alone predicts 30-day hospital readmission after coronary artery bypass graft surgery. Eur J Cardiovasc Prev Rehabil. 2008; 15(2):210-5. DOI: 10.1097/HJR.0b013e3282f2dc4e. View

15.

Haymart M, Banerjee M, Stewart A, Koenig R, Birkmeyer J, Griggs J . Use of radioactive iodine for thyroid cancer. JAMA. 2011; 306(7):721-8. PMC: 3352591. DOI: 10.1001/jama.2011.1139. View

16.

Joynt K, Orav E, Jha A . Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA. 2011; 305(7):675-81. PMC: 3332042. DOI: 10.1001/jama.2011.123. View

17.

Geronimus A . Invited commentary: Using area-based socioeconomic measures--think conceptually, act cautiously. Am J Epidemiol. 2006; 164(9):835-40. DOI: 10.1093/aje/kwj314. View

18.

Krumholz H, Lin Z, Drye E, Desai M, Han L, Rapp M . An administrative claims measure suitable for profiling hospital performance based on 30-day all-cause readmission rates among patients with acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2011; 4(2):243-52. PMC: 3350811. DOI: 10.1161/CIRCOUTCOMES.110.957498. View

19.

Arbaje A, Wolff J, Yu Q, Powe N, Anderson G, Boult C . Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries. Gerontologist. 2008; 48(4):495-504. DOI: 10.1093/geront/48.4.495. View

20.

Keenan P, Normand S, Lin Z, Drye E, Bhat K, Ross J . An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2009; 1(1):29-37. DOI: 10.1161/CIRCOUTCOMES.108.802686. View