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Variations in 30-day hospital readmission rates across primary care clinics within a tertiary referral center.
J Hosp Med. 2014 Nov; 9(11):688-94.JH

Abstract

BACKGROUND

Reducing hospital readmissions is a national healthcare priority. Little is known about how readmission rates vary across unique primary care practices.

OBJECTIVE

To calculate all-cause 30-day hospital readmission rates at the level of individual primary care practices and identify factors associated with variations in these rates.

DESIGN

Retrospective analysis

SETTING

Seven primary care clinics affiliated with the University of California, San Francisco (UCSF).

PATIENTS

Adults ≥18 years old with a primary care provider (PCP) at UCSF MEASUREMENTS: All-cause 30-day readmission rates were calculated for primary care clinics for discharges between July 1, 2009 and June 30, 2012. We built a model to identify demographic, clinical, and hospital factors associated with variation in rates.

RESULTS

There were 12,564 discharges for patients belonging to the 7 clinics, with 8685 index discharges and 1032 readmissions. Readmission rates varied across practices, from 14.9% in Human Immunodeficiency Virus primary care and 7.7% in women's health. In multivariable analyses, factors associated with variation in readmission rates included: male gender (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.05-1.40), Medicare insurance (OR: 1.31, 95% CI: 1.05, 1.64; Ref = private), Medicare-Medicaid dual eligible (OR: 1.26, 95% CI: 1.01-1.56), multiple comorbidities, and admitting services. Patients with a departed PCP awaiting transfer assignment to a new PCP had an OR of 1.59 (95% CI: 1.16-2.17) compared with having a current faculty PCP.

CONCLUSIONS

Primary care practices are important partners in improving care transitions and reducing hospital readmissions, and this study introduces a new way to view readmission rates. PCP turnover may be an important risk factor for hospital readmissions.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Tang N
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
Maselli JH
No affiliation info available
Gonzales R
No affiliation info available

MeSH

Academic Medical CentersAdolescentAdultAgedAged, 80 and overComorbidityFemaleHumansMaleMedicaidMedicareMiddle AgedModels, TheoreticalMultivariate AnalysisPatient ReadmissionPrimary Health CareReferral and ConsultationRetrospective StudiesSan FranciscoSex DistributionSocioeconomic FactorsTertiary Care CentersUnited StatesYoung Adult

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25130292

Citation

Tang, Ning, et al. "Variations in 30-day Hospital Readmission Rates Across Primary Care Clinics Within a Tertiary Referral Center." Journal of Hospital Medicine, vol. 9, no. 11, 2014, pp. 688-94.
Tang N, Maselli JH, Gonzales R. Variations in 30-day hospital readmission rates across primary care clinics within a tertiary referral center. J Hosp Med. 2014;9(11):688-94.
Tang, N., Maselli, J. H., & Gonzales, R. (2014). Variations in 30-day hospital readmission rates across primary care clinics within a tertiary referral center. Journal of Hospital Medicine, 9(11), 688-94. https://doi.org/10.1002/jhm.2243
Tang N, Maselli JH, Gonzales R. Variations in 30-day Hospital Readmission Rates Across Primary Care Clinics Within a Tertiary Referral Center. J Hosp Med. 2014;9(11):688-94. PubMed PMID: 25130292.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variations in 30-day hospital readmission rates across primary care clinics within a tertiary referral center. AU - Tang,Ning, AU - Maselli,Judith H, AU - Gonzales,Ralph, Y1 - 2014/08/06/ PY - 2013/10/12/received PY - 2014/07/08/revised PY - 2014/07/17/accepted PY - 2014/8/19/entrez PY - 2014/8/19/pubmed PY - 2015/6/27/medline SP - 688 EP - 94 JF - Journal of hospital medicine JO - J Hosp Med VL - 9 IS - 11 N2 - BACKGROUND: Reducing hospital readmissions is a national healthcare priority. Little is known about how readmission rates vary across unique primary care practices. OBJECTIVE: To calculate all-cause 30-day hospital readmission rates at the level of individual primary care practices and identify factors associated with variations in these rates. DESIGN: Retrospective analysis SETTING: Seven primary care clinics affiliated with the University of California, San Francisco (UCSF). PATIENTS: Adults ≥18 years old with a primary care provider (PCP) at UCSF MEASUREMENTS: All-cause 30-day readmission rates were calculated for primary care clinics for discharges between July 1, 2009 and June 30, 2012. We built a model to identify demographic, clinical, and hospital factors associated with variation in rates. RESULTS: There were 12,564 discharges for patients belonging to the 7 clinics, with 8685 index discharges and 1032 readmissions. Readmission rates varied across practices, from 14.9% in Human Immunodeficiency Virus primary care and 7.7% in women's health. In multivariable analyses, factors associated with variation in readmission rates included: male gender (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.05-1.40), Medicare insurance (OR: 1.31, 95% CI: 1.05, 1.64; Ref = private), Medicare-Medicaid dual eligible (OR: 1.26, 95% CI: 1.01-1.56), multiple comorbidities, and admitting services. Patients with a departed PCP awaiting transfer assignment to a new PCP had an OR of 1.59 (95% CI: 1.16-2.17) compared with having a current faculty PCP. CONCLUSIONS: Primary care practices are important partners in improving care transitions and reducing hospital readmissions, and this study introduces a new way to view readmission rates. PCP turnover may be an important risk factor for hospital readmissions. SN - 1553-5606 UR - https://www.unboundmedicine.com/medline/citation/25130292/Variations_in_30_day_hospital_readmission_rates_across_primary_care_clinics_within_a_tertiary_referral_center_ DB - PRIME DP - Unbound Medicine ER -