Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Short-term (30-day) hospital readmissions are a major financial burden for the Medicare system. Low socioeconomic status (SES) and a hospital's safety-net status are important factors associated with higher hospital readmission rates. Post–acute care (PAC) location may also be affected by SES and subsequently affect post-discharge outcomes. This study examined the associations between SES and PAC location (Aim 1), post-discharge outcomes with PAC location considered (Aim 2), and the associations by safety-net status (Aim 3) to better understand the roles of SES and PAC location in affecting post-discharge outcomes.
The study identified Medicare Current Beneficiary Survey Fee-for-Service participants with inpatient hospitalizations from 2006 to 2011. SES was measured at the individual level (dual-eligibility, income, and educational level) and the area level (the Area Deprivation Index). The 30-day post-discharge outcomes included hospital readmission, hospice/death, or neither. PAC locations based on Medicare claims included home health, skilled nursing facility, inpatient rehabilitation facilities (Aim 1 only), or home. Multinomial logistic regressions were used, comparing models using variables from claims data versus the full set of variables from provider files, area health resources, and survey data. Inverse probability weights were used to control for selection of PAC location (Aims 2 & 3).
The results suggested that dual-eligible patients were more likely to use SNFs, while patients living in deprived areas were less likely to use SNFs. Overall, readmission rates were higher for dual than non-dual patients. Dual patients had slightly higher readmission rates in safety-net than in non-safety-net hospitals. Controlling for additional variables including the SES measures of income and education and PAC locations increased the explanatory power of the models but did not substantively change the associations.
The study results supported the important roles of dual-eligibility and area deprivation level in predicting PAC locations and post-discharge outcomes as well as the role of safety-net status in the post-discharge outcomes. This study aimed to help policy makers understand ways to address the disadvantage for safety-net hospitals, and to contribute to efforts to ensure access for vulnerable patients with limited resources while promoting high-quality health care and reimbursement commensurate with costs.