Impact of care coordination based on insurance and zip code

Area of Science:

• Health Services Research
• Cardiology
• Health Economics

Background:

• Care transitions programs aim to reduce hospital readmissions.
• Socioeconomic factors like insurance status and neighborhood poverty can influence healthcare outcomes.
• Percutaneous coronary intervention (PCI) patients are at risk for rehospitalization.

Purpose of the Study:

• To evaluate if the Bridges care transitions program differentially impacted rehospitalizations among PCI patients based on insurance and socioeconomic status.
• To identify disparities in the effectiveness of care transitions interventions.

Main Methods:

• Retrospective observational cohort study comparing PCI patients in a care transitions program (Bridges) with a historical control group.
• Socioeconomic status assessed by insurance type and zip code poverty level.
• Negative binomial regression used to analyze rehospitalization rates, including interaction terms for insurance and poverty.

Main Results:

• The Bridges program was associated with a 15.5% lower rehospitalization rate for Medicaid patients in wealthy zip codes compared to Medicare patients.
• Medicaid patients in the poorest zip codes and those with dual Medicare/Medicaid status experienced higher rehospitalization rates post-intervention.
• A significant interaction was found between insurance status and poverty level regarding rehospitalization.

Conclusions:

• The Bridges intervention showed a benefit for Medicaid patients in wealthier communities but not in poorer ones.
• Care transitions programs may have differential effects on patient outcomes depending on the socioeconomic context of their community.
• Further research is needed to address socioeconomic disparities in post-PCI care transitions.