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The Role of Outpatient Facilities in Explaining Variations in Risk-Adjusted Readmission Rates between Hospitals

Authors

  • Scott A. Lorch,

    1. Department of Pediatrics, Center for Outcomes Research, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine; 3535 Market Street, Suite 1029, Philadelphia, PA 19104
    2. The Leonard Davis Institute of Health Economics, The University of Pennsylvania; 3535 Market Street, Suite 1029, Philadelphia, PA 19104
    3. Division of Neonatology, The Children's Hospital of Philadelphia; 3535 Market Street, Suite 1029, Philadelphia, PA 19104
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    • Address correspondence to Scott A. Lorch, M.D., M.S.C.E., Department of Pediatrics, Center for Outcomes Research, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine; The Leonard Davis Institute of Health Economics, The University of Pennsylvania; Division of Neonatology, The Children's Hospital of Philadelphia; 3535 Market Street, Suite 1029, Philadelphia, PA 19104; email: lorch@email.chop.edu. Michael Baiocchi, B.A., is with the Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA. Jeffrey H. Silber, M.D., Ph.D., is with the Center for Outcomes Research, The Children's Hospital of Philadelphia; Departments of Pediatrics and Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine; Department of Health Care Management, The Wharton School, The University of Pennsylvania; The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA. Orit Even-Shoshan, M.S., is with the The Children's Hospital of Philadelphia, Center for Outcomes Research, The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA. Gabriel J. Escobar, M.D., is with the Systems Research Initiative & Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, CA. Dylan S. Small, Ph.D., is with the Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA.

  • Michael Baiocchi,

    1. Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA
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  • Jeffrey H. Silber,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
    2. Departments of Pediatrics and Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA
    3. Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA
    4. The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
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  • Orit Even-Shoshan,

    1. The Children's Hospital of Philadelphia, Center for Outcomes Research, The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
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  • Gabriel J. Escobar,

    1. Systems Research Initiative & Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, CA
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  • Dylan S. Small

    1. Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA.
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Abstract

Objective. Validate risk-adjusted readmission rates as a measure of inpatient quality of care after accounting for outpatient facilities, using premature infants as a test case.

Study Setting. Surviving infants born between January 1, 1998 and December 12, 2001 at five Northern California Kaiser Permanente neonatal intensive care units (NICU) with 1-year follow-up at 32 outpatient facilities.

Study Design. Using a retrospective cohort of premature infants (N=898), Poisson's regression models determined the risk-adjusted variation in unplanned readmissions between 0–1 month, 0–3 months, 3–6 months, and 3–12 months after discharge attributable to patient factors, NICUs, and outpatient facilities.

Data Collection. Prospectively collected maternal and infant hospital data were linked to inpatient, outpatient, and pharmacy databases.

Principal Results. Medical and sociodemographic factors explained the largest amount of variation in risk-adjusted readmission rates. NICU facilities were significantly associated with readmission rates up to 1 year after discharge, but the outpatient facility where patients received outpatient care can explain much of this variation. Characteristics of outpatient facilities, not the NICUs, were associated with variations in readmission rates.

Conclusion. Ignoring outpatient facilities leads to an overstatement of the effect of NICUs on readmissions and ignores a significant cause of variations in readmissions.

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