ABSTRACT

We study a large intervention intended to reduce hospital readmission rates in Israel. Since 2012, readmission risk was calculated for patients aged 65 and older, and high-risk patients were flagged to providers upon admission and after discharge. Analyzing 171,541 admissions during 2009–2016, we find that the intervention reduced 30-day readmission rates by 5.9% among patients aged 65–70 relative to patients aged 60–64, who were not targeted by the intervention and for whom no risk-scores were calculated. The largest reduction, 12.3%, was among high-risk patients, though some of it may reflect substitution of attention away from patients with unknown high-risk at the point of care. Post-discharge follow-up encounters were significantly expedited. Estimated effects declined after incentives to reduce readmission rates were discontinued. The evidence demonstrates that informing providers about patient risk in real-time coupled with incentives to reduce readmissions can improve care continuity and reduce hospital readmissions.

摘要

我们研究了旨在降低以色列住院率的大型干预措施。自2012年以来，计算了65岁及65岁以上患者的再入院风险，高危患者在入院时和出院后被标记给提供者。分析2009-2016年期间的171,541名患者，我们发现该干预措施使65-70岁患者的30天再入院率相对于60-64岁年龄段的患者而言降低了5.9％，而60-64岁年龄段的患者没有被干预作为目标，并且没有风险分值被计算。最大的降低是12.3％，是高危患者，尽管其中有些可能反映出在护理时将注意力转移到了未知高危患者身上。出院后的跟进活动大大加快了。终止降低再入院率的激励措施后，估计效果有所下降。