Impact of Hospital Medical Homes on Potentially Preventable Readmissions in New York State
This research examines the association between potentially preventable readmission (PPR) rates in New York State (NYS) hospitals who participated in the Hospital Medical Home (HMH) demonstration compared to those that did not. This research also examines the association between PPR rates and other hospital characteristics.
The HMH demonstration was a two-year project involving 60 teaching hospitals which was carried out 2013-2014. The objectives of the demonstration were to transform outpatient department sites into medical homes and teach medical home concepts to residents in order to improve care coordination, continuity and quality of care. It is hypothesized that improved care coordination will decrease rates of PPRs.
PPR rates for 2011-2013 at hospitals in NYS (adjusted for patient age group, mental health status, severity of illness, and All Patient Refined Diagnosis Related Group) were collected from the Health Data NY website. Hospital characteristics were extracted from the NYS Health Facilities Information System and teaching hospitals were identified using NYS Department of Health Medicaid Graduate Medical Education funding rosters. Metropolitan and nonmetropolitan hospitals were identified using the National Center for Health Statistics classification scheme based on the United States Department of Agriculture (USDA) rural/urban continuum codes. The classification system from AHRQ’s Healthcare Cost and Utilization Project was used to define hospital size based on number of beds.
The changes in risk-adjusted PPR rates over time were assessed between HMH and non-HMH hospitals using linear regression, controlling for rural/urban continuum code. Other variables such as teaching status and hospital size did not enhance the model. Additionally, mean comparison analyses were used to determine associations between PPR rates and HMH participation, teaching hospital designation, location in NYC or other metropolitan area, and hospital size. Outliers and influential observations were removed prior to analysis.
Risk-adjusted PPR rates decreased from 2011-2013 in both HMH hospitals (p=0.001) and non-HMH hospitals (p=0.013). In the linear regression model, the rural/urban continuum codes are a statistically significant predictive factor (p<0.001) for the variations in PPR rates over time while HMH participation is not a statistically significant predictive factor (p=0.106). Separate t-test analyses on hospital characteristics showed that metropolitan hospitals had a greater decrease in PPR rates than nonmetropolitan hospitals from 2011-2013 (p=0.086).
While there is no clear association between HMH participation and changes in PPR rates over time, there is an association between urban/rural classification and changes in PPR rates from 2011-2013 in NYS.
Learning Areas:Conduct evaluation related to programs, research, and other areas of practice
Public health or related research
Evaluate the association between potentially preventable readmission rates in New York State hospitals who participated in the Hospital Medical Home demonstration compared to those that did not. Assess the association between potentially preventable readmission rates in New York State hospitals and other hospital characteristics.
Keyword(s): Patient-Centered Care, Quality Improvement
Qualified on the content I am responsible for because: I am a Healthcare Program Specialist in the Medical Homes Unit in the Division of Performance Improvement and Patient Safety in the Office of Quality and Patient Safety at the New York State Department of Health. I contribute to the Data Group for the Hospital Medical Home Demonstration. I combined available data sets, cleaned the data, and performed the statistical analysis for this research project.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.