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Objective To evaluate whether changes in diagnosis assignment explain reductions in 30-day readmission for patients with pneumonia following the Hospital Readmission Reduction Program (HRRP). Data sources 100 percent MedPAR, 2008-2015. Study design Retrospective cohort study of Medicare discharges in HRRP-eligible hospitals. Outcomes were 30-day readmission rates for pneumonia under a "narrow" definition (used for the HRRP until October 2015; n = 2 288 644) and a "broad" definition that included certain diagnoses of sepsis and aspiration pneumonia (used since October 2015; n = 3 618 215). We estimated changes in 30-day readmissions in the pre-HRRP period (January 2008-March 2010), the HRRP implementation period (April 2010-September 2012), and the HRRP penalty period (October 2012-June 2015). Principal findings Under the narrow definition, adjusted annual readmission rates changed by +0.07 percentage points (pp) during the pre-HRRP period (95% CI: -0.03 pp, +0.18 pp), -1.07 pp during HRRP implementation (95% CI: -1.15 pp, -0.99 pp), and -0.09 pp during the penalty period (95% CI: -0.18 pp, -0.00 pp). Under the broad definition, 30-day readmissions changed by +0.21 pp during the pre-HRRP period (95% CI: +0.12 pp, +0.30 pp), -1.28 pp during HRRP implementation (95% CI: -1.35 pp, -1.21 pp), and -0.09 pp during the penalty period (95% CI: -0.16 pp, -0.02 pp). Conclusions Changes in the coding of inpatient pneumonia admissions do not explain readmission reduction following the HRRP.

Disturbances in the self-concept are broadly recognized as a psychosocial risk factor in the etiology of the eating disorders and as such, have been identified an important focus in the eating disorder psychotherapies (for examples see Fairburn, Cooper & Shafran, 2003; Wonderlich et al, 2008). Yet despite the centrality of self-concept disturbances in theoretical models of the disorders, theoretically derived and empirically supported interventions that target changes in the self-concept as the mechanism of eating disorder symptom change and health recovery are lacking. In this paper, we report results of a randomized trial of a new psychotherapy for the eating disorders of anorexia nervosa (AN) and bulimia nervosa (BN), referred to as the identity intervention program (IIP). IIP is based on an empirically supported model that focuses on impairments in organizational properties of the total collection of self-cognitions, referred to as self-schemas, as a key determinant of the maladaptive attitudes and behaviors that characterize the disorders. The IIP seeks to build new positive self-schemas that are distinct and separate from other conceptions of the self in memory as the means to promote recovery and health. The trial examined whether IIP in combination with nutritional counseling would be more effective than supportive psychotherapy and nutritional counseling in reducing the attitudinal and behavioral symptoms that characterize the eating disorders and improving functional health and psychological well-being.