TY - JOUR T1 - Association of Post-discharge Service Types and Timing with 30-Day Readmissions, Length of Stay, and Costs. AU - Tak,Hyo Jung, AU - Goldsweig,Andrew M, AU - Wilson,Fernando A, AU - Schram,Andrew W, AU - Saunders,Milda R, AU - Hawking,Michael, AU - Gupta,Tanush, AU - Yuan,Cindy, AU - Chen,Li-Wu, Y1 - 2021/05/13/ PY - 2020/02/24/received PY - 2021/03/09/accepted PY - 2021/5/15/pubmed PY - 2021/8/26/medline PY - 2021/5/14/entrez KW - Hospital Readmission Reduction Program KW - all-cause index admission KW - post-discharge services utilization KW - service types KW - unplanned 30-day readmission SP - 2197 EP - 2204 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 36 IS - 8 N2 - 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. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/33987792/Association_of_Post_discharge_Service_Types_and_Timing_with_30_Day_Readmissions_Length_of_Stay_and_Costs_ DB - PRIME DP - Unbound Medicine ER -