Association of Post-discharge Service Types and Timing with 30-Day Readmissions, Length of Stay, and Costs

Hyo Jung Tak, Andrew M. Goldsweig, Fernando A. Wilson, Andrew W. Schram, Milda R. Saunders, Michael Hawking, Tanush Gupta, Cindy Yuan, Li-Wu Chen

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Although early follow-up after discharge from an index admission (IA) has been postulated to reduce 30-day readmission, some researchers have questioned its efficacy, which may depend upon the likelihood of readmission at a given time and the health conditions contributing to readmissions. Objective: To investigate the relationship between post-discharge services utilization of different types and at different timepoints and unplanned 30-day readmission, length of stay (LOS), and inpatient costs. Design, Setting, and Participants: The study sample included 583,199 all-cause IAs among 2014 Medicare fee-for-service beneficiaries that met IA inclusion criteria. Main Measures: The outcomes were probability of 30-day readmission, average readmission LOS per IA discharge, and average readmission inpatient cost per IA discharge. The primary independent variables were 7 post-discharge health services (institutional outpatient, primary care physician, specialist, non-physician provider, emergency department (ED), home health care, skilled nursing facility) utilized within 7 days, 14 days, and 30 days of IA discharge. To examine the association with post-discharge services utilization, we employed multivariable logistic regressions for 30-day readmissions and two-part models for LOS and inpatient costs. Key Results: Among all IA discharges, the probability of unplanned 30-day readmission was 0.1176, the average readmission LOS per discharge was 0.67 days, and the average inpatient cost per discharge was $5648. Institutional outpatient, home health care, and primary care physician visits at all timepoints were associated with decreased readmission and resource utilization. Conversely, 7-day and 14-day specialist visits were positively associated with all three outcomes, while 30-day visits were negatively associated. ED visits were strongly associated with increases in all three outcomes at all timepoints. Conclusion: Post-discharge services of different types and at different timepoints have varying impacts on 30-day readmission, LOS, and costs. These impacts should be considered when coordinating post-discharge follow-up, and their drivers should be further explored to reduce readmission throughout the health care system.

Original languageEnglish (US)
Pages (from-to)2197-2204
Number of pages8
JournalJournal of general internal medicine
Volume36
Issue number8
DOIs
StatePublished - Aug 2021

Keywords

  • Hospital Readmission Reduction Program
  • all-cause index admission
  • post-discharge services utilization
  • service types
  • unplanned 30-day readmission

ASJC Scopus subject areas

  • Internal Medicine

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