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Physician financial incentives to reduce unplanned hospital readmissions : An interrupted time series analysis Staples, John; Liu, Guiping; Brubacher, Jeffrey; Karimuddin, Ahmer; Sutherland, Jason M.
Abstract
BACKGROUND: In 2012, the Ministry of Health in British Columbia, Canada, introduced a $75 incentive payment that could be claimed by hospital physicians each time they produced a written post-discharge care plan for a complex patient at the time of hospital discharge. OBJECTIVE: To examine whether physician financial payments incentivizing enhanced discharge planning reduce subsequent unplanned hospital readmissions. DESIGN: Interrupted time series analysis of population-based hospitalization data. PARTICIPANTS: Individuals with one or more eligible hospitalizations occurring in British Columbia between 2007 and 2017. MAIN MEASURES: The proportion of index hospital discharges with subsequent unplanned hospital readmission within 30 days, as measured each month of the 11-year study interval. We used interrupted time series analysis to determine if readmission risk changed after introduction of the incentive payment policy. KEY RESULTS: A total of 40,588 unplanned hospital readmissions occurred among 409,289 eligible index hospitalizations (crude 30-day readmission risk, 9.92%). Policy introduction was not associated with a significant step change (0.393%; 95CI, -0.190% to 0.975%; p = 0.182) or change-in-trend (p = 0.317) in monthly readmission risk. Policy introduction was associated with significantly fewer prescription fills for potentially inappropriate medications among older patients, but no improvement in prescription fills for beta-blockers after cardiovascular hospitalization and no change in 30-day mortality. Incentive payment uptake was incomplete, rising from 6.4% to 23.5% of eligible hospitalizations between the first and last year of the postpolicy interval. CONCLUSION: The introduction of a physician incentive payment was not associated with meaningful changes in hospital readmission rate, perhaps in part because of incomplete uptake by physicians. Policymakers should consider these results when designing similar interventions elsewhere
Item Metadata
Title |
Physician financial incentives to reduce unplanned hospital readmissions : An interrupted time series analysis
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Alternate Title |
Physician incentives to reduce hospital readmissions
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Creator | |
Contributor | |
Publisher |
Springer
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Date Issued |
2021-05-04
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Description |
BACKGROUND: In 2012, the Ministry of Health in British Columbia, Canada, introduced a $75
incentive payment that could be claimed by hospital physicians each time they produced a
written post-discharge care plan for a complex patient at the time of hospital discharge.
OBJECTIVE: To examine whether physician financial payments incentivizing enhanced discharge
planning reduce subsequent unplanned hospital readmissions.
DESIGN: Interrupted time series analysis of population-based hospitalization data.
PARTICIPANTS: Individuals with one or more eligible hospitalizations occurring in British
Columbia between 2007 and 2017.
MAIN MEASURES: The proportion of index hospital discharges with subsequent unplanned
hospital readmission within 30 days, as measured each month of the 11-year study interval. We
used interrupted time series analysis to determine if readmission risk changed after
introduction of the incentive payment policy.
KEY RESULTS: A total of 40,588 unplanned hospital readmissions occurred among 409,289
eligible index hospitalizations (crude 30-day readmission risk, 9.92%). Policy introduction was
not associated with a significant step change (0.393%; 95CI, -0.190% to 0.975%; p = 0.182) or
change-in-trend (p = 0.317) in monthly readmission risk. Policy introduction was associated
with significantly fewer prescription fills for potentially inappropriate medications among older
patients, but no improvement in prescription fills for beta-blockers after cardiovascular
hospitalization and no change in 30-day mortality. Incentive payment uptake was incomplete,
rising from 6.4% to 23.5% of eligible hospitalizations between the first and last year of the postpolicy interval. CONCLUSION: The introduction of a physician incentive payment was not associated with
meaningful changes in hospital readmission rate, perhaps in part because of incomplete uptake
by physicians. Policymakers should consider these results when designing similar interventions
elsewhere
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Subject | |
Genre | |
Type | |
Language |
eng
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Date Available |
2022-05-16
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Provider |
Vancouver : University of British Columbia Library
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Rights |
Attribution-NonCommercial-NoDerivatives 4.0 International
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DOI |
10.14288/1.0413605
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URI | |
Affiliation | |
Citation |
Staples JA, Liu G, Brubacher JR, Karimuddin AK, Sutherland JM. Physician financial incentives to reduce unplanned hospital readmissions: An interrupted time series analysis. Journal of General Internal Medicine. 2021 Nov;36(11):3431-3440
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Publisher DOI |
10.1007/s11606- 021-06803-8
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Peer Review Status |
Reviewed
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Scholarly Level |
Faculty; Researcher
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Rights URI | |
Aggregated Source Repository |
DSpace
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Rights
Attribution-NonCommercial-NoDerivatives 4.0 International