Evidence map›Paper›PMID 32919590›Full record

ArticleHealthcare (Amsterdam, Netherlands)2020

Substantial hospital level variation in all-cause readmission rates among medicare beneficiaries with serious mental illness.

Hayley D Germack, Zhadyra Bizhanova, Eric T Roberts

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Article in Healthcare (Amsterdam, Netherlands), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

3 authors.

Hayley D GermackDepartment of Acute & Tertiary Care University of Pittsburgh School of Nursing, 3500 Victoria Street 336 Victoria Building, Pittsburgh, PA, 15261, USA. Electronic address: hdg8@pitt.edu.
Zhadyra BizhanovaGraduate School of Public Health University of Pittsburgh, 3500 Victoria Street, 361 Victoria Building, Pittsburgh, PA, 15261, USA. Electronic address: zhb10@pitt.edu.
Eric T RobertsDepartment of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, USA. Electronic address: eric.roberts@pitt.edu.

Funding

Financial assistance for low-income Medicare beneficiaries: Using natural experiments to assess effects on care and health outcomesK01HS026727 · AHRQ · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI ROBERTS, ERIC T · 2019 to 2022
$545k
AHRQ HHS K01 HS026727
6 · The paper itself

Abstract

backgroundPatients with serious mental illness (i.e., SMI; bipolar disorder, major depressive disorder, and schizophrenia) are at increased risk of readmission, yet little is known about the extent to which readmission rates among these patients vary across hospitals. The purpose of this study was to examine the variation across hospitals in readmissions for patients with SMI and differences in the characteristics of hospitals with the highest and lowest adjusted readmission rates.

methodsWe conducted a cross-sectional analysis of pooled inpatient claims from 2013-2016. Mixed logit models with hospital random effects were used to estimate the hospital-level variance. The sample included patients with SMI from a 5% sample of fee-for-service Medicare beneficiaries.

resultsWe identified 2066 hospitals with at least 30 index admissions for Medicare beneficiaries with SMI. In multivariate analyses, factors most strongly associated with increased risk of readmission included substance use disorder (OR 2.311; p < 0.001) and end stage renal disease (OR 2.024; p < 0.001). Unadjusted readmission for hospitals at the 5th and 95th percentiles of performance were 7.05% and 15.24%, respectively, constituting an 8.2% difference. Adjusting for patient and community characteristics reduced the spread in readmission rates between the 5th and 95th percentiles of hospitals by 1.0% (i.e. to 7.2%). Hospitals in the lowest vs. highest quintiles of adjusted readmission rates were more likely to be teaching hospitals (11.1% vs. 16.7%; p < 0.05) and located in the South (37.7% vs. 40.4%) or Midwest (19.8% vs. 30.0%; p < 0.001 for region differences).

conclusionsThere is substantial hospital-level variation in readmission rates among patients with serious mental illness, even after adjusting for patient and community characteristics. This has implications for policy guiding investment in hospital-based services and community resources, to improve transitions of care for patients with SMI.

Indexed as

AgedAged, 80 and overCross-Sectional StudiesFemaleHospitalizationHospitalsHumansLogistic ModelsMaleMedicareMental DisordersMiddle AgedPatient ReadmissionUnited StatesGeneral medical readmissionsHospital variationPsychiatric comorbidity

Identifiers

PMID32919590
PMCPMC7495504

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.