A readmissions-reduction program targeting high-risk Medicare fee-for-service patients appeared to be effective, despite achieving only half its goal, according to a recent study.
Researchers conducted a quasi-experimental evaluation of the Greater New Haven Coalition for Safe Transitions and Readmission Reductions (Co-STARR) program, which, from 2012 to 2014, was implemented at Yale-New Haven Hospital's 2 campuses and funded by CMS’ Community-based Care Transitions Program with the goal of reducing 30-day readmissions by 20%. Results were published online on April 11 by JAMA Internal Medicine.
As part of the intervention, transitional care consultants (about 4 at any given time) followed up with high-risk patients after discharge, providing medication management, support services, and clarification of discharge instructions. Consultants, who were social workers from the Area Agency on Aging, made home visits when necessary in order to further assess patients' needs.
In their analysis, researchers looked at a postintervention group of 18,223 discharged patients, 10,621 of whom (58.3%) were enrolled in Co-STARR, receiving an average of 4.3 interventions per patient. Patients in this group were older than 64 years (mean age, 79.7 years), were insured by Medicare, and resided in nearby ZIP codes.
The researchers compared all these patients to a control group of those older than 54 years with the same ZIP codes but without Medicare fee-for-service if older than 64 years (20,077 discharges). Researchers noted that their intervention population differed from the control population by being older, more female, more white, and more often discharged to a facility.
The adjusted readmission rate decreased from 21.5% to 19.5% in the target population and from 21.1% to 21.0% in the control population, a relative reduction of 9.3%. In the intervention period, the odds of readmission decreased significantly more in the target population than in the control population (odds ratio, 0.90; 95% CI, 0.83 to 0.99; P=0.03). The number needed to treat to prevent 1 readmission was 50, and researchers estimated that the $1.5 million-per-year program would cost about $7,000 per avoided readmission (although this compares favorably to $12,200, the mean Medicare payment for a hospitalization in 2012).
The results show “fairly consistent and sustained but small, beneficial effect of the intervention,” the authors said, adding that “CMS goals of reducing all readmissions by 20% may be overambitious.” They noted several limitations to the study, such as its observational design and how it was conducted at a single site and may not be generalizable to other settings. However, they measured outcomes in the entire target population yet only enrolled 58.3% of patients in Co-STARR, which likely resulted in a conservative estimate of the intervention effect, they said.