• Steven B Spivack, Darren DeWalt, Jonathan Oberlander, Justin Trogdon, Nilay Shah, Ellen Meara, Morris Weinberger, Kristin Reiter, Devang Agravat, Carrie Colla, and Valerie Lewis.
• Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. steven.spivack@yale.edu.
• J Gen Intern Med. 2022 Sep 1; 37 (12): 300530123005-3012.

BackgroundA great deal of research has focused on how hospitals influence readmission rates. While hospitals play a vital role in reducing readmissions, a significant portion of the work also falls to primary care practices. Despite this critical role of primary care, little empirical evidence has shown what primary care characteristics or activities are associated with reductions in hospital admissions.ObjectiveTo examine the relationship between practices' readmission reduction activities and their readmission rates.Design, Setting, And ParticipantsA retrospective study of 1,788 practices who responded to the National Survey of Healthcare Organizations and Systems (fielded 2017-2018) and 415,663 hospital admissions for Medicare beneficiaries attributed to those practices from 2016 100% Medicare claims data. We constructed mixed-effects logistic regression models to estimate practice-level readmission rates and a linear regression model to evaluate the association between practices' readmission rates with their number of readmission reduction activities.InterventionsStandardized composite score, ranging from 0 to 1, representing the number of a practice's readmission reduction capabilities. The composite score was composed of 12 unique capabilities identified in the literature as being significantly associated with lower readmission rates (e.g., presence of care manager, medication reconciliation, shared-decision making, etc.).Main Outcomes And MeasuresPractices' readmission rates for attributed Medicare beneficiaries.Key ResultsRoutinely engaging in more readmission reduction activities was significantly associated (P < .05) with lower readmission rates. On average, practices experienced a 0.05 percentage point decrease in readmission rates for each additional activity. Average risk-standardized readmission rates for practices performing 10 or more of the 12 activities in our composite measure were a full percentage point lower than risk-standardized readmission rates for practices engaging in none of the activities.ConclusionsPrimary care practices that engaged in more readmission reduction activities had lower readmission rates. These findings add to the growing body of evidence suggesting that engaging in multiple activities, rather than any single activity, is associated with decreased readmissions.© 2021. Society of General Internal Medicine.

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