The building blocks of hospital readmission analysis are Medicare Part A claims for inpatient care. Analysis is complicated, however, by vagaries of the claims, including overlapping dates of care across multiple claims, adjoining dates possibly reflecting transfers between hospitals, and revisions for proper reimbursement. These vagaries must be carefully addressed before analysis commences.
During 2011, there were 571,737 live discharges among patients who received chronic dialysis treatment upon discharge; 95 percent occurred in patients who received chronic dialysis treatment both before and after hospitalization. Most discharges were made by short-term and critical access hospitals. Among such hospitals with at least one discharge, there was wide variation in the cumulative number of discharges during the year. Approximately 34 percent of hospitals made just 1–10 discharges during 2011. Another 23 percent made 11–100 discharges during the year. For the remainder of hospitals, 101–500 discharges were typical; only 6.5 percent made more than 500 discharges during 2011.
Discharge status is determined by the hospital and attending physician, and often reflects the overall condition of the patient. Among discharges made by short-term and critical access hospitals, patients were typically discharged to home, under self-care; a skilled nursing facility; or home, under the supervision of a home health agency. Other statuses comprised only 6.3 percent of discharges.
Among the three principal statuses, the 30-day readmission rate was lowest for patients discharge to home, under self-care (32.1 percent); intermediate for patients discharged to home, under supervision of a home health agency (37.9 percent); and highest for patients discharged to a skilled nursing facility (39.7 percent). The probability of death in the 30 days following live discharge followed the same trend among the three statuses.
Patient status among live discharges to chronic dialysis in 2011.
Type of inpatient facility among live discharges to chronic dialysis in 2011.
Discharge status among live discharges to chronic dialysis in 2011.
Cumulative number of live discharges to chronic dialysis in 2011, per hospital.
30-day readmission and death rates among live discharges to chronic dialysis in 2011.