Abstract
Objective
To determine the relative effects of patient and hospital factors on a hospital’s postpartum readmission rate.
Study design
This retrospective cohort study was conducted using State Inpatient Databases from California, Florida, and New York between 2004 and 2013. We compared patient and hospital characteristics among hospitals with low and high readmission rates using χ2 tests. Risk-adjusted 30-day readmission rates were calculated for patient, delivery, and hospital characteristics to understand factors affecting readmission using fixed and random effects models.
Results
Patients in hospitals with low readmission rates were more likely to be white, to have private insurance and higher incomes, and to have fewer comorbidities. The patient comorbidities with the highest risk-adjusted readmission rates included hypertension (range, 2.14–3.04%), obesity (1.78–2.94%), preterm labor/delivery (2.50–2.60%), and seizure disorder (1.78–3.35%). Delivery complications were associated with increased risk-adjusted readmission rates. Compared to patient characteristics, hospital characteristics did not have a profound impact on readmission risk.
Conclusion
Obstetric readmissions were more attributable to patient and demographic characteristics than to hospital characteristics. Readmission metric-based incentives may ultimately penalize hospitals providing high-quality care due to patient characteristics specific to their catchment area.
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Acknowledgements
This work was supported by an institutional grant awarded to the authors by the Center of Expertise in Health Policy and Management from the Partners Healthcare Office of Graduate Medical Education.
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Clapp, M.A., Little, S.E., Zheng, J. et al. The relative effects of patient and hospital factors on postpartum readmissions. J Perinatol 38, 804–812 (2018). https://doi.org/10.1038/s41372-018-0125-8
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DOI: https://doi.org/10.1038/s41372-018-0125-8
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