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Do Transition Clinics Reduce Hospital Re-admissions Among Elderly?
Authors: Barbara Guerard; Raymond Harvey; Bisakha Sen
Reducing avoidable hospital readmissions is considered to be particularly important in controlling healthcare costs. The purpose of this study is to evaluate if a Transitions Clinic intervention is associated with reducing the risk of re-admission among hospital patients enrolled in a Medicare Advantage (MA) plan in Southeast Louisiana.
Previous research has demonstrated that patients who have a clear understanding of their after- hospital care instructions and an understanding of how to take their medications and keep early follow up appointments with their physician demonstrate substantial reductions in avoidable readmissions (Costantino, Frey, Hall, & Painter, 2013; Robinson, Howie-Esquivel, & Vlahov, 2012). The MA plan in question is interested in whether establishing post discharge transitions clinics for members who underwent hospital admissions might be a useful intervention to reduce avoidable readmissions. To further investigate this, the organization used 2011-2012 data from a large contracted parish(county) hospital that implemented a transitions clinic in early 2012 , to study the impact that the transitions in careintervention on readmission rates for the plans enrollees. Corresponding data from another hospital was used as a ‘control’ group.
We used an ‘Intent to Treat’ (ITT) approach, and considered re-admission risk for all non-surgical patients in the treatment versus control group. We estimated standard difference-in-difference models, and then also estimated triple DDD models, taking advantage of the fact that surgical patients were not referred to the transition clinic, and hence could be used as an additional comparison or control group. We estimated multivariate linear probability models. Models also controlled for other patient characteristics, including age, gender, race, dual (i.e. Medicare-Medicaid status), and use of other health services such as visiting the primary care physician (PCP) within 7 days of discharge .
We used data on a total of 13,164 discharged patients (N=2344 for intervention group in 2011, N=2125 for intervention group in 2012, N=3779 for control group in 2011, N=4916 for control group in 2012). Thirty-day hospital readmission rates for the pooled sample was approximately 10 percent.
Preliminary results from our difference-in-difference analysis indicates that the presence of the clinic was associated with a negative, albeit not statistically significant, change in readmission rates. However, certain other patient-level factors, such as a PCP visit within 7 days of discharge, were significantly associated with lower 30-day re-admission rates. The next steps in this project will include completing the triple DDD analysis, as well as evaluating the rate at which patients actually use the transition clinic upon discharge from the hospital, and what factors predict the likelihood of such use.