An examination of 30-day readmissions by demographic groups and hospital characteristics in North Carolina Medicare enrollees

The Affordable Care Act increased attention on hospital outcomes through the Hospital Readmissions Reduction Program, which will reduce inpatient prospective payments to hospitals with excess readmissions for select conditions. Excessive hospital readmissions are associated with lower patient satisfaction and higher costs. We aim to understand the demographic characteristics of Medicare patients in North Carolina who are re-admitted within 30-days of discharge for acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN), and variations in readmission rates by region and hospital size.  This study utilizes North Carolina state-level data from the 2010 Hospital Cost and Utilization Project (HCUP).  HCUP data includes a revisit variable that allows for patients to be tracked across hospitals and entry points (i.e., inpatient, emergency department, and ambulatory surgery) as well as establishes time between index event and re-admission.  Frequencies are calculated for demographic variables, including gender, age, presence of co-morbidities, length of initial stay, and readmitting condition. Reflecting the literature in the area, the analyses are stratified by region (Mountains, Coastal and Piedmont) and hospital size determined by the number of beds.  Analysis of variance are conducted to determine if differences exist between the mean readmissions rates by demographic groups within and between the hospital characteristics.  The results of this study enable early identification of patients at highest risk of readmission, by patient demographics and hospital characteristics of AMI, HF, and PN hospital patients.