Variation Among Primary Care Physicians in 30-Day Readmissions.
Ann Intern Med
; 170(11): 749-755, 2019 06 04.
Article
en En
| MEDLINE
| ID: mdl-31108502
ABSTRACT
Background:
Whether readmission rates vary by primary care physician (PCP) is unknown, although federal policy holds PCPs accountable for reducing readmissions.Objective:
To determine whether 30-day readmission rates vary by PCP.Design:
Retrospective cohort study using marginal models and multilevel logistic regression with 100% of data on Texas Medicare claims from 2008 to 2015.Setting:
Texas.Participants:
Patients discharged alive between 1 January 2008 and 30 November 2015 who had a PCP in the prior year and whose PCP had at least 50 admissions in the study period. Measurements Readmission within 30 days of discharge. Follow-up visits with a PCP within 7 days of discharge were also measured.Results:
Between 2012 and 2015, the mean risk-standardized rate of 30-day readmissions was 12.9%. Of 4230 PCPs, 1 had a readmission rate that was significantly higher than the mean and none had a significantly lower rate. The 10th and 90th percentiles of PCP readmission rates were 12.4% and 13.4%, respectively, each only 0.5 percentage point different from the mean. The 99th percentile of PCP readmission rates was 14.0%, 1.1 percentage points higher than the mean. Detecting a 1.1-percentage point difference from the mean adjusted readmission rate would require more than 3500 admissions per PCP per year.Limitations:
Only fee-for-service Medicare patients in a single state were included. The authors could not account for confounders not included in Medicare databases or classify readmissions as avoidable.Conclusion:
Variation in readmission rates among PCPs is very low. Programs holding PCPs accountable for readmissions may prove ineffective. Primary Funding Source National Institutes of Health.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Readmisión del Paciente
/
Pautas de la Práctica en Medicina
/
Médicos de Atención Primaria
Tipo de estudio:
Observational_studies
Límite:
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Ann Intern Med
Año:
2019
Tipo del documento:
Article