Development and Validation of an Administrative Claims-based Measure for All-cause 30-day Risk-standardized Readmissions After Discharge From Inpatient Psychiatric Facilities.
Administrative Claims, Healthcare
/ statistics & numerical data
Adult
Aged
Aged, 80 and over
Female
Humans
Inpatients
Male
Medicare
Mental Disorders
/ diagnosis
Middle Aged
Patient Discharge
Patient Readmission
/ statistics & numerical data
Psychiatric Department, Hospital
Quality Indicators, Health Care
Reproducibility of Results
Retrospective Studies
Risk Adjustment
United States
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
entrez:
28
2
2020
pubmed:
28
2
2020
medline:
10
5
2020
Statut:
ppublish
Résumé
The objective of this study was to develop and test a measure that estimates unplanned, 30-day, all-cause risk-standardized readmission rates (RSRRs) after inpatient psychiatric facility (IPF) discharge. We established a retrospective cohort of adults with a principal diagnosis of psychiatric illness or dementia discharged from IPFs to nonacute care settings, using 2012-2013 Medicare fee-for-service claims data. All-cause unplanned readmissions within 3-30 days post-IPF discharge were assessed by constructing then validating a parsimonious logistic regression model of 56 risk factors (selected via empirical data, systematic literature review, clinical expert opinion) for readmission using bootstrapping. RSRRs were calculated from the ratio of predicted versus expected readmission rates for each IPF using hierarchical regression. Measure reliability and validity were assessed via multiple strategies. The measure development cohort included 716,174 admissions to 1679 IPFs and 149,475 (20.9%) readmissions. Most readmissions (>80%) had principal diagnoses of mood, schizoaffective or substance use disorders, delirium/dementia, infections or drug/substance poisoning. Facility RSRRs ranged from 11.0% to 35.4%. The risk adjustment model showed good calibration and moderate discrimination similar to other readmission risk models (c statistic 0.66). Sensitivity analyses solidified the risk modeling approach. The intraclass correlation coefficient of estimated IPF RSRRs was 0.78, indicating good reliability. The measure identified 8.3% of hospitals as having better and 13.4% as having worse RSRRs than the national readmission rate. The measure provides an assessment of facility-level quality and insight into risk factors useful for informing preventive interventions. The measure will be included in the Centers for Medicare and Medicaid Services (CMS) Inpatient Psychiatric Quality Reporting program in 2019.
Identifiants
pubmed: 32106165
doi: 10.1097/MLR.0000000000001275
pii: 00005650-202003000-00006
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
225-233Références
Medicare.gov. Hospital Compare—Measures and current data collection periods; 2018. Available at: www.medicare.gov/hospitalCompare/Data/data-updated.html#MG16. Accessed September 11, 2018.
CMS.gov. Long term care hospital quality reporting measures information. 2018. Available at: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Reporting-Measures-Information.html. Accessed September 11, 2018.
CMS.gov. Skilled nursing facility value-based purchasing program. 2018. Available at: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Other-VBPs/SNF-VBP.html. Accessed September 11, 2018.
CMS.gov. Inpatient rehabilitation facility quality reporting measures information. 2018. Available at: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/IRF-Quality-Reporting-Program-Measures-Information-.html. Accessed September 11, 2018.
Bailey MK, Weiss AJ, Barrett ML, et al. Characteristics of 30-day all-cause hospital readmissions, 2010-2016: statistical brief #248. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality (US); 2006:1–10.
National Association of Psychiatric Health Systems. Medicare psychiatric patients and readmissions in the inpatient psychiatric facility prospective payment system; 2013. Available at: www.nabh.org/wp-content/uploads/2018/06/Medicare-Psychiatric-Readmissions.FINAL_.05082013.pdf. Accessed August 20, 2018.
MedPAC. Inpatient psychiatric facility services payment system; 2014.
Durbin J, Lin E, Layne C, et al. Is readmission a valid indicator of the quality of inpatient psychiatric care? J Behav Health Serv Res. 2007;34:137–150.
Steffen S, Kösters M, Becker T, et al. Discharge planning in mental health care: a systematic review of the recent literature. Acta Psychiatr Scand. 2009;120:1–9.
Winterstein A, Bussing R, Keenan M, et al. Inpatient psychiatric facility all-cause readmission measure version 1.0—technical report; 2016: 60. Available at: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Measure-Methodology.html. Accessed March 22, 2018.
Centers for Medicare and Medicaid Services. Thirty-Day All-Cause Unplanned Readmission following Psychiatric Hospitalization in an Inpatient Psychiatric Facility (IPF); 2016. Available at: https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=2800. Accessed August 28, 2018.
Horwitz L, Grady J, Zhang W, et al. Measure updates and specifications report: hospital-wide all-cause unplanned readmission measure—version 4.0. Centers for Medicare & Medicaid Services; 2015.
Healthcare Cost and Utilization Project (HCUP). Clinical Classifications Software (CCS) for ICD-9-CM. 2017. Available at: www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed August 20, 2018.
Medicare. Getting Medicare if you have a disability; 2019. Available at: www.medicare.gov/information-for-my-situation/getting-medicare-if-you-have-a-disability. Accessed July 17, 2019.
Horwitz LI, Grady JN, Zhang W, et al. Measure updates and specifications report: hospital-wide all-cause unplanned readmission measure—version 4.0; 2015. Available at: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Measure-Methodology.html.
Carr VJ, Lewin TJ, Sly KA, et al. Adverse incidents in acute psychiatric inpatient units: rates, correlates and pressures. Aust N Z J Psychiatry. 2008;42:267–282.
Mellesdal L, Mehlum L, Wentzel-Larsen T, et al. Suicide risk and acute psychiatric readmissions: a prospective cohort study. Psychiatr Serv. 2010;61:25–31.
Bowersox NW, Saunders SM, Berger BD. Predictors of rehospitalization in high-utilizing patients in the VA psychiatric medical system. Psychiatr Q. 2012;83:53–64.
Stein BD, Pangilinan M, Sorbero MJ, et al. Using claims data to generate clinical flags predicting short-term risk of continued psychiatric hospitalizations. Psychiatr Serv. 2014;65:1341–1346.
Jaramillo-Gonzalez LE, Sanchez-Pedraza R, Herazo MI. The frequency of rehospitalization and associated factors in Colombian psychiatric patients: a cohort study. BMC Psychiatry. 2014;14:161.
Frick U, Frick H, Langguth B, et al. The revolving door phenomenon revisited: time to readmission in 17,145 [corrected] patients with 37,697 hospitalisations at a German psychiatric hospital. PLoS One. 2013;8:e75612.
Botha UA, Koen L, Joska JA, et al. The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country. Soc Psychiatry Psychiatr Epidemiol. 2010;45:461–468.
Schennach R, Obermeier M, Meyer S, et al. Predictors of relapse in the year after hospital discharge among patients with schizophrenia. Psychiatr Serv. 2012;63:87–90.
Tulloch AD, David AS, Thornicroft G. Exploring the predictors of early readmission to psychiatric hospital. Epidemiol Psychiatr Sci. 2016;25:181–193.
Lay B, Lauber C, Rossler W. Prediction of in-patient use in first-admitted patients with psychosis. Eur Psychiatry. 2006;21:401–409.
Ilgen MA, Hu KU, Moos RH, et al. Continuing care after inpatient psychiatric treatment for patients with psychiatric and substance use disorders. Psychiatr Serv. 2008;59:982–988.
Payne RA, Oliver JJ, Bain M, et al. Patterns and predictors of re-admission to hospital with self-poisoning in Scotland. Public Health. 2009;123:134–137.
Manu P, Khan S, Radhakrishnan R, et al. Body mass index identified as an independent predictor of psychiatric readmission. J Clin Psychiatry. 2014;75:e573–e577.
Munk-Olsen T, Laursen TM, Pedersen CB, et al. First-time first-trimester induced abortion and risk of readmission to a psychiatric hospital in women with a history of treated mental disorder. Arch Gen Psychiatry. 2012;69:159–165.
Prince JD, Akincigil A, Kalay E, et al. Psychiatric rehospitalization among elderly persons in the United States. Psychiatr Serv. 2008;59:1038–1045.
Irmiter C, McCarthy JF, Barry KL, et al. Reinstitutionalization following psychiatric discharge among VA patients with serious mental illness: a national longitudinal study. Psychiatr Q. 2007;78:279–286.
Zhang J, Harvey C, Andrew C. Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study. Aust N Z J Psychiatry. 2011;45:578–585.
Silva NC, Bassani DG, Palazzo LS. A case-control study of factors associated with multiple psychiatric readmissions. Psychiatr Serv. 2009;60:786–791.
Woo BK, Golshan S, Allen EC, et al. Factors associated with frequent admissions to an acute geriatric psychiatric inpatient unit. J Geriatr Psychiatry Neurol. 2006;19:226–230.
Martinez-Ortega JM, Gutierrez-Rojas L, Jurado D, et al. Factors associated with frequent psychiatric admissions in a general hospital in Spain. Int J Soc Psychiatry. 2012;58:532–535.
Gunnell D, Hawton K, Ho D, et al. Hospital admissions for self harm after discharge from psychiatric inpatient care: cohort study. BMJ. 2008;337:a2278.
Heggestad T, Lilleeng SE, Ruud T. Patterns of mental health care utilisation: distribution of services and its predictability from routine data. Soc Psychiatry Psychiatr Epidemiol. 2011;46:1275–1282.
Lin CH, Chen YS, Lin KS. Factors affecting time to rehospitalization for patients with major depressive disorder. Psychiatry Clin Neurosci. 2007;61:249–254.
Prince JD, Akincigil A, Hoover DR, et al. Substance abuse and hospitalization for mood disorder among Medicaid beneficiaries. Am J Public Health. 2009;99:160–167.
Lin CH, Chen WL, Lin CM, et al. Predictors of psychiatric readmissions in the short- and long-term: a population-based study in Taiwan. Clinics (Sao Paulo). 2010;65:481–489.
Pasic J, Russo J, Roy-Byrne P. High utilizers of psychiatric emergency services. Psychiatr Serv. 2005;56:678–684.
Morlino M, Calento A, Schiavone V, et al. Use of psychiatric inpatient services by heavy users: findings from a national survey in Italy. Eur Psychiatry. 2011;26:252–259.
Valevski A, Zalsman G, Tsafrir S, et al. Rate of readmission and mortality risks of schizophrenia patients who were discharged against medical advice. Eur Psychiatry. 2012;27:496–499.
Lin CH, Chen MC, Chou LS, et al. Time to rehospitalization in patients with major depression vs. those with schizophrenia or bipolar I disorder in a public psychiatric hospital. Psychiatry Res. 2010;180:74–79.
Kroken RA, Mellesdal LS, Wentzel-Larsen T, et al. Time-dependent effect analysis of antipsychotic treatment in a naturalistic cohort study of patients with schizophrenia. Eur Psychiatry. 2012;27:489–495.
Mahendran R, Mythily, Chong SA, et al. Brief communication: factors affecting rehospitalisation in psychiatric patients in Singapore. Int J Soc Psychiatry. 2005;51:101–105.
Romelsjo A, Palmstierna T, Hansagi H, et al. Length of outpatient addiction treatment and risk of rehospitalization. J Subst Abuse Treat. 2005;28:291–296.
Pfiffner C, Steinert T, Kilian R, et al. Rehospitalization risk of former voluntary and involuntary patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2014;49:1719–1727.
Ju PC, Chou FH, Lai TJ, et al. Long-acting injectables and risk for rehospitalization among patients with schizophrenia in the home care program in Taiwan. J Clin Psychopharmacol. 2014;34:23–29.
Zilber N, Hornik-Lurie T, Lerner Y. Predictors of early psychiatric rehospitalization: a national case register study. Isr J Psychiatry Relat Sci. 2011;48:49–53.
Lin CH, Chen CC, Wang SY, et al. Factors affecting time to rehospitalization in Han Chinese patients with schizophrenic disorder in Taiwan. Kaohsiung J Med Sci. 2008;24:408–414.
Lin CH, Lin SC, Chen MC, et al. Comparison of time to rehospitalization among schizophrenic patients discharged on typical antipsychotics, clozapine or risperidone. J Chin Med Assoc. 2006;69:264–269.
Kim HM, Pfeiffer P, Ganoczy D, et al. Intensity of outpatient monitoring after discharge and psychiatric rehospitalization of veterans with depression. Psychiatr Serv. 2011;62:1346–1352.
Rosca P, Bauer A, Grinshpoon A, et al. Rehospitalizations among psychiatric patients whose first admission was involuntary: a 10-year follow-up. Isr J Psychiatry Relat Sci. 2006;43:57–64.
Choi M, Kim H, Qian H, et al. Readmission rates of patients discharged against medical advice: a matched cohort study. PLoS One. 2011;6:e24459.
Oyffe I, Kurs R, Gelkopf M, et al. Revolving-door patients in a public psychiatric hospital in Israel: cross sectional study. Croat Med J. 2009;50:575–582.
Wung YT, Chen CC, Chen FC, et al. Schizophrenia patients discharged against medical advice at a mental hospital in Taiwan. Psychiatry Clin Neurosci. 2010;64:415–420.
Krivoy A, Fischel T, Zahalka H, et al. Outcomes of compulsorily admitted schizophrenia patients who agreed or disagreed to prolong their hospitalization. Compr Psychiatry. 2012;53:995–999.
Valevski A, Olfson M, Weizman A, et al. Risk of readmission in compulsorily and voluntarily admitted patients. Soc Psychiatry Psychiatr Epidemiol. 2007;42:916–922.
Moss J, Li A, Tobin J, et al. Predictors of readmission to a psychiatry inpatient unit. Compr Psychiatry. 2014;55:426–430.
National Quality Forum. Evaluation of the NQF trial period for risk adjustment for social risk factors–final report; 2017. Available at: www.qualityforum.org/Publications/2017/07/Social_Risk_Trial_Final_Report.aspx. Accessed September 11, 2018.
Pope G, Ellis R. Diagnostic Cost Group Hierarchical Condition Category Models for Medicare Risk Adjustment; 2000. Available at: www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/pope_2000_2.pdf. Accessed August 28, 2018.
Stute W, Manteiga WG, Quindimil MP. Bootstrap approximations in model checks for regression. Available at: http://dx.doi.org/10.1080/01621459.1998.10474096. Accessed February 17, 2012.
Steyerberg EW, Bleeker SE, Moll HA, et al. Internal and external validation of predictive models: a simulation study of bias and precision in small samples. J Clin Epidemiol. 2003;56:441–447.
Harrell F. Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York, NY: Springer; 2001.
Efron B, Gong G. A Leisurely Look at the Bootstrap, the Jackknife, and Cross-Validation. Am Stat. 1983;37:36–48.
Landis J, Koch G. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.
CMS.gov. A blueprint for the CMS measures management system v11.1; 2015. Available at: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Downloads/Blueprint111.pdf. Accessed August 20, 2018.
National Quality Forum. Measure evaluation criteria and guidance for evaluating measures for endorsement; 2015. Available at: www.qualityforum.org/Measuring_Performance/Submitting_Standards.aspx. Accessed August 20, 2018.
Krumholz HM, Brindis RG, Brush JE, et al. Standards for statistical models used for public reporting of health outcomes: an American Heart Association Scientific Statement from the Quality of Care and Outcomes Research Interdisciplinary Writing Group: cosponsored by the Council on Epidemiology and Prevention and the Stroke Council. Endorsed by the American College of Cardiology Foundation. Circulation. 2006;113:456–462.
Horwitz LI, Partovian C, Lin Z, et al. Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission. Ann Intern Med. 2014;161(suppl):S66–S75.
Keenan PS, Normand SL, Lin Z, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2008;1:29–37.
Krumholz HM, Wang Y, Mattera JA, et al. An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with an acute myocardial infarction. Circulation. 2006;113:1683–1692.
Krumholz HM, Lin Z, Drye EE, et al. An administrative claims measure suitable for profiling hospital performance based on 30-day all-cause readmission rates among patients with acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2011;4:243–252.
Lindenauer PK, Normand SL, Drye EE, et al. Development, validation, and results of a measure of 30-day readmission following hospitalization for pneumonia. J Hosp Med. 2011;6:142–150.
Assistant Secretary for Planning and Evaluation (ASPE). Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Programs, A Report Required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; 2016. Available at: https://aspe.hhs.gov/system/files/pdf/253971/ASPESESRTCfull.pdf. Accessed August 29, 2018.
DE Hert M, Correll CU, Bobes J, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10:52–77.
Mark TL, Mark T, Tomic KS, et al. Hospital readmission among medicaid patients with an index hospitalization for mental and/or substance use disorder. J Behav Health Serv Res. 2013;40:207–221.