Little variation seen in readmission rates between primary care physicians in Texas

1. In this retrospective cohort study, there was very little variation in 30-day readmission rates between different primary care physicians (PCPs).

2. Programs holding PCPs accountable for readmissions may be ineffective.

Evidence Rating Level: 2 (Good)

Study Rundown: Readmissions are costly for the patient and the healthcare system and may be the result of poor care and follow up. In this retrospective cohort study, Texas Medicare claims data was used to determine the average risk-standardized 30-day readmission rate and assess whether this varied between PCPs. They found that the average 30-day readmission rate was 12.9% with very little variation in readmission rates between different PCPs. However, there was significant variation in rate of seven-day post-discharge follow-up between PCPs and different patient populations. Strengths of this study included a large, inclusive cohort from an accurate and validated dataset.  Limitations of this study included generalizability as the study population only included Medicare patients in Texas. The study was retrospective in nature and only Medicare claims data was used for analysis. Thus, there was no clinical correlation and no assessment of avoidable versus unavoidable admissions. Overall, when patient characteristics were controlled for, the readmission rates among different PCPs were not found to be significantly different. Based on these findings the authors concluded that pay-for-performance programs for PCPs may not be effective for reducing readmission rates.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Rehospitalizations among patients in the medicare fee-for-service program

In-Depth [retrospective cohort study]: This study was a retrospective cohort study using Texas Medicare claims data between January 2007-December 2015. Two cohorts were created, one to assess 30-day readmission rate and another to look at PCP follow up within one week of hospital discharge. Exclusion criteria were transfer to another acute care hospital, death during hospitalization or within the 30-day period, no identifiable PCP, and those whose PCPs had fewer than 50 admissions in a year. For each PCP, the risk-standardized 30-day readmission rate was calculated (ratio of predicted to expected number of readmissions, multiplied by national unadjusted rate of readmission). Between 2012-2015, average risk-standardized readmission rate was 12.9%. Of the 4230 PCPs within the cohort, only one PCP had a significantly higher readmission rate, none had a significantly lower rate. There was only a 1.1 percentage point difference between the 99th percentile readmission rate and the mean, which would require more than 3500 admissions per PCP per year to detect a significant difference. The overall rate of seven-day post discharge follow up was 20.4%. Patients were more likely to be seen if they were older, male, Hispanic, had an emergent admission, or resided in a more educated neighborhood. They were less likely to be seen if they were black, overweight, or had frequent hospitalizations within the past year.

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