Relationship Between Insurance and 30-Day Readmission Rates in Patients 65 Years and Older Discharged From an Acute Care Hospital With Hospice Services

    loading  Checking for direct PDF access through Ovid

Abstract

BACKGROUND

Patients who are dual eligible for both Medicare and Medicaid have previously been shown to have increased healthcare utilization and cost. However, this relationship has not been examined for patients at the end of life. Dual eligible patients enrolled in hospice may receive more comprehensive care in the community, reducing readmissions in the final weeks or months of life.

OBJECTIVE

Determine whether patients who have dual coverage with Medicare and Medicaid and are discharged with referral to hospice services after palliative care consult during their hospitalization differ in their 30-day readmission rate compared with similar patients with other types of insurance.

DESIGN

Retrospective cohort study.

SETTING

Three acute care hospitals affiliated with Montefiore Medical Center in the Bronx, New York.

PATIENTS

In total, 2755 inpatients who received palliative care consultation and were discharged with hospice services.

PREDICTOR

Dual eligible for Medicare and Medicaid compared with other insurance status.

MEASUREMENTS

Readmission to Montefiore Medical Center for any reason within 30 days of the index admission.

RESULTS

Overall, 9.24% of patients with dual Medicare and Medicaid coverage were readmitted within 30 days compared with 13.12% of others (adjusted odds ratio: 0.77; 95% confidence interval: 0.59–0.98; P = 0.041).

CONCLUSIONS

Dual eligibility for Medicare and Medicaid is associated with lower 30-day readmission rates in patients enrolled in a hospice program. Insurance coverage that increases access to custodial care (home attendant hours and residential care) may help decrease burdensome hospital readmissions near the end of life.

Related Topics

    loading  Loading Related Articles