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Spillover Effects of the Hospital Readmissions Reduction Program on Radical Cystectomy Readmissions
Matthew S Lee1, Brent K Hollenbeck1, Mary K Oerline1
1Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Insights
Hospitals focused on reducing readmissions for joint replacements did not see similar improvements for radical cystectomy patients. This suggests tailored strategies are needed for different surgical procedures to lower readmission rates.
Area of Science:
- Urology
- Health Services Research
- Health Policy
Background:
- Radical cystectomy has high readmission rates, impacting hospital performance metrics.
- The Hospital Readmissions Reduction Program (HRRP) incentivizes hospitals to reduce readmissions for targeted conditions like joint arthroplasty.
- Potential spillover effects of HRRP interventions on non-targeted surgeries remain unclear.
Purpose of the Study:
- To investigate if hospital efforts to reduce readmissions for HRRP-targeted major joint surgery influenced radical cystectomy readmission rates.
- To determine if a "spillover effect" exists from interventions aimed at hip and knee arthroplasty readmissions to cystectomy readmissions.
Main Methods:
- Analysis of a 20% Medicare beneficiary sample (2010-2014) for patients undergoing radical cystectomy.
- Stratification of hospitals into quartiles based on improvement in reducing targeted hip and knee arthroplasty readmissions.
- Multivariable logistic regression to assess the association between hospital performance quartile and radical cystectomy readmission rates.
Main Results:
- A cohort of 2,394 patients undergoing radical cystectomy was analyzed.
- No significant difference in 30-day readmission rates for radical cystectomy was observed between hospitals most improved in reducing joint surgery readmissions (26%) and those least improved (24%).
- The adjusted odds ratio for a spillover effect was 0.90 (p=0.42), indicating no statistically significant association.
Conclusions:
- Hospitals achieving reductions in readmissions for major joint surgery did not demonstrate similar success for radical cystectomy.
- The findings suggest that HRRP interventions for targeted procedures do not automatically translate to improvements in other surgical areas.
- Tailored, condition-specific strategies are likely necessary to effectively reduce readmission rates for radical cystectomy and other non-targeted surgeries.
Introduction And Objective:
Readmission rates after radical cystectomy are among the highest of any surgery. The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals with excess readmissions for certain targeted conditions, including total hip and knee arthroplasty. We examined whether changes made by hospitals in response to the HRRP had spillover effects on radical cystectomy readmissions.
Methods:
We used a 20% sample of Medicare data to identify patients undergoing cystectomy from 2010 to 2014 and measured 30-day adjusted cystectomy readmission rates. To determine the effect of the HRRP, we calculated adjusted readmission rates following total hip or knee arthroplasty and stratified hospitals into quartiles (most improved, middle quartiles, least improved) based on their improvement in reducing those targeted readmissions. Multivariable logistic regression was used to identify factors associated with spillover effects from the targeted joint surgery to cystectomy.
Results:
We identified 2,394 patients undergoing radical cystectomy. Of these, 606 were treated at hospitals in the "most improved" quartile and 522 in the "least improved." Patients undergoing cystectomy were similar in age, comorbidity, and SEC independent of hospital performance quartile. The readmission rate following cystectomy was 26% in the most improved quartile and 24% in the least improved. No spillover effect was identified between readmission reduction after major joint surgery and radical cystectomy (adjusted OR 0.90, p=0.42).
Conclusions:
Hospitals that succeeded in reducing readmissions following major joint surgery targeted by the HRRP did not have similar reductions in readmissions following radical cystectomy. This lack of spillover effect suggests that each surgical condition may require tailored interventions to prevent readmissions.
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