Inquiry J Health Car
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Inquiry J Health Car · Jan 1991
Trends in length of stay and rates of readmission in Massachusetts: implications for monitoring quality of care.
In this study, we examined lengths of stay and readmission rates for all Medicare patients discharged from Massachusetts acute care hospitals from October 1982 through September 1986. Using multivariate time series models, we controlled for case mix and assessed trends over time and the impact of prospective payment on lengths of stay and rates of readmission within 7, 14, and 30 days of discharge. We examined patterns for patients overall and for those admitted initially with one of several specific medical conditions or for a surgical procedure. ⋯ Overall readmission rates within 7 and 14 days increased by approximately 10% (p less than .05), although the increase was not statistically associated with prospective payment. Readmission rates for individual medical and surgical conditions were not significantly changed. Further study should assess whether the change in overall rates reflects lower quality care.
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This study focuses on the relationship between the quality and the cost of hospital care. I report the findings of variable cost regressions that include outcome indicators of hospital quality: risk-adjusted mortality and readmission indices. ⋯ Results show several quality measures to be statistically significant determinants of cost. With each measure, the cost-quality relationship is nonlinear but not monotonically increasing throughout the entire range of quality.