通过解决健康的社会决定因素减少再入院人数

IF 3.1 2区 经济学 Q1 ECONOMICS
W. Evans, Sarah Kroeger, Elizabeth L Munnich, Grace Ortuzar, Kathryn L. Wagner
{"title":"通过解决健康的社会决定因素减少再入院人数","authors":"W. Evans, Sarah Kroeger, Elizabeth L Munnich, Grace Ortuzar, Kathryn L. Wagner","doi":"10.1086/711725","DOIUrl":null,"url":null,"abstract":"Hospital readmissions generate enormous costs and are the subject of increased scrutiny among US lawmakers. The Affordable Care Act created the Community-Based Care Transitions Program (CCTP) to test models for improving care transitions after hospital discharge with the goal of reducing 30-day Medicare hospital readmission rates by 20 percent. Few of these demonstrations showed sustained reductions in readmission rates. In contrast to more traditional medically focused programs, the Chicago Southland Coalition for Transition Care (CSCTC) utilized social workers solely to manage care transitions in an effort to address nonmedical obstacles to recovery. Using a difference-in-differences model and the census of Medicare discharges over the 2010–15 period, we evaluate the impact of this program. We select as a comparison group hospitals in the Chicago area with similar pretreatment trends in readmission rates and total discharges. Treatment-on-treated estimates indicate that the CSCTC program reduced 30-, 60-, and 90-day readmission rates by a statistically significant 14 percent or more of the sample mean, and reduced readmission costs an amount equal to CSCTC program cost. Effects are driven by black and Hispanic patients as well as those with dual eligibility for both Medicare and Medicaid.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"7 1","pages":"1 - 40"},"PeriodicalIF":3.1000,"publicationDate":"2020-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/711725","citationCount":"11","resultStr":"{\"title\":\"Reducing Readmissions by Addressing the Social Determinants of Health\",\"authors\":\"W. Evans, Sarah Kroeger, Elizabeth L Munnich, Grace Ortuzar, Kathryn L. Wagner\",\"doi\":\"10.1086/711725\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Hospital readmissions generate enormous costs and are the subject of increased scrutiny among US lawmakers. The Affordable Care Act created the Community-Based Care Transitions Program (CCTP) to test models for improving care transitions after hospital discharge with the goal of reducing 30-day Medicare hospital readmission rates by 20 percent. Few of these demonstrations showed sustained reductions in readmission rates. In contrast to more traditional medically focused programs, the Chicago Southland Coalition for Transition Care (CSCTC) utilized social workers solely to manage care transitions in an effort to address nonmedical obstacles to recovery. Using a difference-in-differences model and the census of Medicare discharges over the 2010–15 period, we evaluate the impact of this program. We select as a comparison group hospitals in the Chicago area with similar pretreatment trends in readmission rates and total discharges. Treatment-on-treated estimates indicate that the CSCTC program reduced 30-, 60-, and 90-day readmission rates by a statistically significant 14 percent or more of the sample mean, and reduced readmission costs an amount equal to CSCTC program cost. Effects are driven by black and Hispanic patients as well as those with dual eligibility for both Medicare and Medicaid.\",\"PeriodicalId\":45056,\"journal\":{\"name\":\"American Journal of Health Economics\",\"volume\":\"7 1\",\"pages\":\"1 - 40\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2020-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1086/711725\",\"citationCount\":\"11\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Health Economics\",\"FirstCategoryId\":\"96\",\"ListUrlMain\":\"https://doi.org/10.1086/711725\",\"RegionNum\":2,\"RegionCategory\":\"经济学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ECONOMICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Health Economics","FirstCategoryId":"96","ListUrlMain":"https://doi.org/10.1086/711725","RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ECONOMICS","Score":null,"Total":0}
引用次数: 11

摘要

再次入院会产生巨大的成本,也是美国立法者越来越多审查的对象。《平价医疗法案》创建了基于社区的医疗过渡计划(CCTP),以测试改善出院后医疗过渡的模型,目标是将30天的医疗保险住院率降低20%。这些示威活动中很少有再次入院率持续下降的。与更传统的以医学为重点的项目相比,芝加哥南部地区过渡护理联盟(CSCTC)仅利用社会工作者来管理护理过渡,以解决康复的非医学障碍。使用差异中的差异模型和2010-2015年期间的医疗保险出院普查,我们评估了该计划的影响。我们选择芝加哥地区在再入院率和总出院率方面具有类似预处理趋势的医院作为比较组。治疗后的治疗估计表明,CSCTC计划将30天、60天和90天的再入院率降低了样本平均值的14%或更多,并将再入院成本降低了相当于CSCTC计划成本的金额。影响是由黑人和西班牙裔患者以及那些既有医疗保险资格又有医疗补助资格的患者造成的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reducing Readmissions by Addressing the Social Determinants of Health
Hospital readmissions generate enormous costs and are the subject of increased scrutiny among US lawmakers. The Affordable Care Act created the Community-Based Care Transitions Program (CCTP) to test models for improving care transitions after hospital discharge with the goal of reducing 30-day Medicare hospital readmission rates by 20 percent. Few of these demonstrations showed sustained reductions in readmission rates. In contrast to more traditional medically focused programs, the Chicago Southland Coalition for Transition Care (CSCTC) utilized social workers solely to manage care transitions in an effort to address nonmedical obstacles to recovery. Using a difference-in-differences model and the census of Medicare discharges over the 2010–15 period, we evaluate the impact of this program. We select as a comparison group hospitals in the Chicago area with similar pretreatment trends in readmission rates and total discharges. Treatment-on-treated estimates indicate that the CSCTC program reduced 30-, 60-, and 90-day readmission rates by a statistically significant 14 percent or more of the sample mean, and reduced readmission costs an amount equal to CSCTC program cost. Effects are driven by black and Hispanic patients as well as those with dual eligibility for both Medicare and Medicaid.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
4.30
自引率
2.70%
发文量
34
期刊介绍: The American Journal of Health Economics (AJHE) provides a forum for the in-depth analysis of health care markets and individual health behaviors. The articles appearing in AJHE are authored by scholars from universities, private research organizations, government, and industry. Subjects of interest include competition among private insurers, hospitals, and physicians; impacts of public insurance programs, including the Affordable Care Act; pharmaceutical innovation and regulation; medical device supply; the rise of obesity and its consequences; the influence and growth of aging populations; and much more.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信