Development and Validation of an Administrative Claims-based Measure for All-cause 30-day Risk-standardized Readmissions After Discharge From Inpatient Psychiatric Facilities

Datos Bibliográficos

ID9103578
AutoresAlmut G Winterstein (0000-0002-6518-5961, Pharmaceutical Outcomes and Policy, autor de correspondencia), Regina Bussing (0000-0001-7931-208X, Psychiatry, University of Florida, Gainesville, FL), Amie J Goodin (0000-0002-0020-8720, autor de correspondencia), Amie Goodin (Pharmaceutical Outcomes and Policy), Dandan Xu (0000-0003-0594-760X, Center for Devices and Radiological Health), Megan Keenan (0009-0005-8244-0337, Health Services Advisory Group (HSAG), Tampa, FL), Kristen Turner (Health Services Advisory Group (HSAG), Tampa, FL), Vinitha Meyyur (Centers for Medicare and Medicaid Services (CMS), Baltimore, MD), Reena Duseja (Centers for Medicare and Medicaid Services (CMS), Baltimore, MD), Kyle Campbell (Health Services Advisory Group (HSAG), Tampa, FL), Kyle N Campbell
Año2020
Volumen58
Número3
Páginas225-233
Fecha de publicación2020-03-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001275
PMID32106165
OpenAlexW2994782862
IdiomaEN
Citas recibidas1
Referencias citadas56

OBJECTIVE: The objective of this study was to develop and test a measure that estimates unplanned, 30-day, all-cause risk-standardized readmission rates (RSRRs) after inpatient psychiatric facility (IPF) discharge. PARTICIPANTS: We established a retrospective cohort of adults with a principal diagnosis of psychiatric illness or dementia discharged from IPFs to nonacute care settings, using 2012-2013 Medicare fee-for-service claims data. MEASURES: All-cause unplanned readmissions within 3-30 days post-IPF discharge were assessed by constructing then validating a parsimonious logistic regression model of 56 risk factors (selected via empirical data, systematic literature review, clinical expert opinion) for readmission using bootstrapping. RSRRs were calculated from the ratio of predicted versus expected readmission rates for each IPF using hierarchical regression. Measure reliability and validity were assessed via multiple strategies. RESULTS: The measure development cohort included 716,174 admissions to 1679 IPFs and 149,475 (20.9%) readmissions. Most readmissions (>80%) had principal diagnoses of mood, schizoaffective or substance use disorders, delirium/dementia, infections or drug/substance poisoning. Facility RSRRs ranged from 11.0% to 35.4%. The risk adjustment model showed good calibration and moderate discrimination similar to other readmission risk models (c statistic 0.66). Sensitivity analyses solidified the risk modeling approach. The intraclass correlation coefficient of estimated IPF RSRRs was 0.78, indicating good reliability. The measure identified 8.3% of hospitals as having better and 13.4% as having worse RSRRs than the national readmission rate. CONCLUSIONS: The measure provides an assessment of facility-level quality and insight into risk factors useful for informing preventive interventions. The measure will be included in the Centers for Medicare and Medicaid Services (CMS) Inpatient Psychiatric Quality Reporting program in 2019

Intraclass correlation · Logistic regression · Psychiatry · Psychometrics · Clinical Psychology · Emergency Medicine · Healthcare Decision-Making and Restraints · Heart Failure Treatment and Management · Internal Medicine · Medicine · Schizophrenia research and treatment