Document Detail


Association between quality improvement for care transitions in communities and rehospitalizations among Medicare beneficiaries.
MedLine Citation:
PMID:  23340640     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
IMPORTANCE: Medicare beneficiaries experience errors during transitions among care settings, yielding harms that include unnecessary rehospitalizations.
OBJECTIVE: To evaluate whether implementation of improved care transitions for patients with Medicare fee-for-service (FFS) insurance is associated with reduced rehospitalizations and hospitalizations in geographic communities.
DESIGN, SETTING, AND PARTICIPANTS: Quality improvement initiative for care transitions by health care and social services personnel and Medicare Quality Improvement Organization staff in defined geographic areas, with monitoring by community-specific and aggregate control charts and evaluation with pre-post comparison of performance differences for 14 intervention communities and 50 comparison communities from before (2006-2008) and during (2009-2010) implementation. Intervention communities had between 22,070 and 90,843 Medicare FFS beneficiaries.
INTERVENTION: Quality Improvement Organizations facilitated community-wide quality improvement activities to implement evidence-based improvements in care transitions by community organizing, technical assistance, and monitoring of participation, implementation, effectiveness, and adverse effects.
MAIN OUTCOME MEASURES: The primary outcome measure was all-cause 30-day rehospitalizations per 1000 Medicare FFS beneficiaries; secondary outcome measures were all-cause hospitalizations per 1000 Medicare FFS beneficiaries and all-cause 30-day rehospitalizations as a percentage of hospital discharges.
RESULTS: The mean rate of 30-day all-cause rehospitalizations per 1000 beneficiaries per quarter was 15.21 in 2006-2008 and 14.34 in 2009-2010 in the 14 intervention communities and was 15.03 in 2006-2008 and 14.72 in 2009-2010 in the 50 comparison communities, with the pre-post between-group difference showing larger reductions in rehospitalizations in intervention communities (by 0.56/1000 per quarter; 95% CI, 0.05-1.07; P = .03). The mean rate of hospitalizations per 1000 beneficiaries per quarter was 82.27 in 2006-2008 and 77.54 in 2009-2010 in intervention communities and was 82.09 in 2006-2008 and 79.48 in 2009-2010 in comparison communities, with the pre-post between-group difference showing larger reductions in hospitalizations in intervention communities (by 2.12/1000 per quarter; 95% CI, 0.47-3.77; P = .01). Mean community-wide rates of rehospitalizations as a percentage of hospital discharges in the intervention communities were 18.97% in 2006-2008 and 18.91% in 2009-2010 and were 18.76% in 2006-2008 and 18.91% in 2009-2010 in the comparison communities, with no significant difference in the pre-post between-group differences (0.22%; 95% CI, -0.08% to 0.51%; P = .14). Process control charts signaled onset of improvement coincident with initiating intervention.
CONCLUSIONS AND RELEVANCE: Among Medicare beneficiaries in intervention communities, compared with those in uninvolved communities, all-cause 30-day rehospitalization and all-cause hospitalization declined. However, there was no change in the rate of all-cause 30-day rehospitalizations as a percentage of hospital discharges.
Authors:
Jane Brock; Jason Mitchell; Kimberly Irby; Beth Stevens; Traci Archibald; Alicia Goroski; Joanne Lynn;
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-23     Completed Date:  2013-01-24     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  381-91     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Delivery of Health Care
Fee-for-Service Plans
Humans
Intervention Studies
Medicare / statistics & numerical data*
Outcome Assessment (Health Care)
Patient Care / standards
Patient Discharge / statistics & numerical data*
Patient Readmission / statistics & numerical data*
Quality Improvement / organization & administration*
Quality of Health Care*
Social Work
United States
Investigator
Investigator/Affiliation:
Don Berwick / ; Kerry Weems / ; Leslie Norwalk / ; Mark McClellan / ; Patrick Conway / ; Barry M Straube / ; Paul E McGann / ; Dennis C Wagner / ; Jean D Moody-Williams / ; William C Rollow / ; Stephen Jencks / ; Traci Archibald / ; Douglas Brown / ; Mary Pratt / ; Joanne Lynn / ; Michael T Rapp / ; Shari Ling / ; Randy Poulsen / ; Tina Dickerson / ; Kimquy Kieu / ; Pamela Frederick / ; Robert T Kambic / ; Cynthia Pamon / ; Jane Brock / ; Alicia Goroski / ; Jason Mitchell / ; Beth Stevens / ; Desiree Froshaug / ; Tom Ventura / ; Kimberly Irby / ; Laura Mankin / ; Grant Hughes / ; Paula Langner / ; Andrew Perlman / ; Lihong Diao / ; Lisa Helseth / ; Marian Boxer / ; Maureen O'Brien / ; Kristine Mattivi / ; Laura Palmer / ; Arja P Adair / ; Wes Smith / ; Dianne M Richmond / ; Sherrie Smith / ; Rashaan Anderson / ; Evadne N Bell-Johnson / ; Jing Li / ; Patricia Richetto / ; Arja P Adair / ; Risa Hayes / ; Hilarea Amthauer / ; Christine LaRocca / ; Katherine Lewandowski / ; Melanie N Kaup / ; Anthony Freedman / ; Susan Stone / ; Beatriz Hernandez / ; Peggy Loesch / ; Cathy Sweet / ; Kristen Turner / ; Debbie Muntner / ; Dennis L White / ; Mary Perloe / ; Mari Lou Keberly / ; Robby Langston / ; Linda Kluge / ; Kimberly Rask / ; Mary Kapur / ; Sandy Hampton / ; Nancy Meadows / ; Holly Davis / ; Ellen Murphy / ; Cheryl Riddell / ; Gary L Curtis / ; Laurie Robinson / ; Scott M Flowers / ; DeeAnn Broussard / ; Kelly Brady / ; Donna Rodrigue / ; Rebecca Hightower / ; Lisa Stansbury / ; Debbie Leone / ; Kathy Langlois / ; Robert Yellan / ; Diane Smith / ; Donna Beebe / ; Barbara J Smith / ; Katie Brown / ; Alyse Grossman / ; Lisa S Tikkanen / ; Tina Georgy / ; Audrey Paulman / ; Janet Dooley / ; Ted Fraser / ; Jennifer Geisert / ; Sandy Kilgore / ; Keri McDermott / ; Paula Sitzman / ; Rama Thummalapalli / ; Martin P Margolies / ; Andrew Miller / ; Ya-ping Su / ; Joyce Pontbriand / ; Judy Miller / ; Suhuang Chen / ; Sai Loganathan / ; Rita Pascale / ; Dawn Cullen / ; Diane Babuin / ; Theodore Will / ; Sara Butterfield / ; Christine Stegel / ; Shelly Glock / ; Joseph O'Donnell / ; John Wiesendanger / ; Naomi Hauser / ; Donna Anderson / ; Suzanne Fritz / ; Michelle Popovich / ; Colleen L Prioletti / ; David Wenner / ; Donald Wilson / ; John Bowers / ; Jill Manna / ; Krista Davis / ; H John Keimig / ; Stefan Gravenstein / ; Rebekah Gardner / ; Rosa Baier / ; Gail Patry / ; Lynne A Chase / ; Kristen Butterfield / ; Maureen Marsella / ; Nelia Silva Odom / ; Karen D'Antonio / ; Rachel Voss / ; Deborah Correia Morales / ; Tom Manley / ; Jennifer Markley / ; Karen Sabharwal / ; Ziyin Wang / ; Cindy Bigbee / ; Janice Toreki / ; Vanessa Andow / ; Mary Healy / ; Jonathan Sugarman / ; Selena Bolotin / ; Sharon Eloranta / ; Evan Stults / ; Carol Higgins / ; Karla Hall / ; Bill Mahoney / ; Suzie Potter / ; Pam Rabe / ; Sen Lu Dimas / ; Seva Kumar /
Comments/Corrections
Comment In:
JAMA. 2013 Jan 23;309(4):394-6   [PMID:  23340642 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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