Institutional Postacute Care Use May Help Reduce Readmissions for Ischemic Stroke Patients
Bibliographic Data
OBJECTIVES: Readmissions for Medicare patients initially admitted for stroke are common and costly. Rehabilitation in an institutional postacute care (PAC) setting is an evidence-based component of recovery for stroke. Under current Medicare payment reforms, care coordination across hospitals and PAC providers is key to improving quality and efficiency of care. We examined the causal impact of institutional PAC use on 30-day readmission rates for Medicare fee-for-service patients initially admitted for ischemic stroke. DATA SOURCES: The 2010-2016 Medicare Provider Analysis and Review files. RESEARCH DESIGN: We used the method of instrumental variable (IV) analysis to control for unobserved differences in the types of patients admitted to each PAC facility. We chose the distance from the patient's residence to the closest institutional PAC provider and the number of PAC providers of each type within a county where the patient resides as IVs. PRINCIPAL FINDINGS: In the naive model, an increase in institutional PAC use was significantly associated with an increase in 30-day readmission by 0.03 percentage points. However, using IV analysis to control for endogeneity bias, an increase in institutional PAC use was associated with a decrease in 30-day readmission rate by 0.19 percentage points. Our findings indicate that reducing institutional PAC use among patients typically requiring rehabilitation in institutional settings for recovery may potentially lead to adverse postdischarge outcomes that require rehospitalization. Thus, payment incentives to reduce institutional PAC use should be balanced with postdischarge outcomes among ischemic stroke patients
Business · Endogeneity · Health care · Incentive · Payment · Physical therapy · Prospective payment system · Residence · Stroke (engine) · Acute Ischemic Stroke Management · Demography · Emergency Medicine · Finance · Heart Failure Treatment and Management · Medicine · Rehabilitation · Stroke Rehabilitation and Recovery
Identification of Causal Effects Using Instrumental Variables
Hospital Characteristics Associated With Risk-standardized Readmission Rates
Comorbidity Measures for Use with Administrative Data
Changes in Use of Postacute Care Associated With Accountable Care Organizations in Hip Fracture, Stroke, and Pneumonia Hospitalized Cohorts
Medicare Spending and Outcomes After Postacute Care for Stroke and Hip Fracture
The Effect of Medicare Shared Savings Program on Readmissions and Variations by Race/Ethnicity and Payer Status (December 9, 2020)
| Citation velocity | historical |
|---|---|
| Highly cited | No |