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The Early Impact of the Centers for MedicareMedicaid Services State Innovation Models Initiative on 30-Day Hospital Readmissions Among Adults With Diabetes
- Source :
- Med Care, Medical care, vol 58 Suppl 6 Suppl 1, iss Suppl 6 1
- Publication Year :
- 2020
-
Abstract
- Background The Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) Initiative funds states to accelerate delivery system and payment reforms. All SIM states focus on improving diabetes care, but SIM's effect on 30-day readmissions among adults with diabetes remains unclear. Methods A quasi-experimental research design estimated the impact of SIM on 30-day hospital readmissions among adults with diabetes in 3 round 1 SIM states (N=671,996) and 3 comparison states (N=2,719,603) from 2010 to 2015. Difference-in-differences multivariable logistic regression models that incorporated 4-group propensity score weighting were estimated. Heterogeneity of SIM effects by grantee state and for CMS populations were assessed. Results In adjusted difference-in-difference analyses, SIM was associated with an increase in odds of 30-day hospital readmission among patients in SIM states in the post-SIM versus pre-SIM period relative to the ratio in odds of readmission among patients in the comparison states post-SIM versus pre-SIM (ratio of adjusted odds ratio=1.057, P=0.01). Restricting the analyses to CMS populations (Medicare and Medicaid beneficiaries), resulted in consistent findings (ratio of adjusted odds ratio=1.057, P=0.034). SIM did not have different effects on 30-day readmissions by state. Conclusions We found no evidence that SIM reduced 30-day readmission rates among adults with diabetes during the first 2 years of round 1 implementation, even among CMS beneficiaries. It may be difficult to reduce readmissions statewide without greater investment in health information exchange and more intensive use of payment models that promote interorganizational coordination.
- Subjects :
- Research design
U.S
media_common.quotation_subject
Logistic regression
Patient Readmission
Centers for Medicare and Medicaid Services, U.S
Article
readmissions
Odds
Organizational
03 medical and health sciences
0302 clinical medicine
Models
Clinical Research
state health policy
Diabetes Mellitus
Medicine
Humans
030212 general & internal medicine
Propensity Score
health care economics and organizations
media_common
business.industry
030503 health policy & services
Public Health, Environmental and Occupational Health
Health information exchange
Odds ratio
Health Services
Centers for Medicare and Medicaid Services
health reform
Payment
Quality Improvement
Organizational Innovation
United States
Good Health and Well Being
Logistic Models
Applied Economics
Models, Organizational
Propensity score matching
Public Health and Health Services
Health Policy & Services
0305 other medical science
business
natural experiments
Medicaid
diabetes care
Demography
Subjects
Details
- ISSN :
- 15371948
- Volume :
- 58
- Database :
- OpenAIRE
- Journal :
- Medical care
- Accession number :
- edsair.doi.dedup.....8a3c86eed1a48b02039bd5ee2de3ec93