地域医療と健康教育

抽象的な

Hospital Readmission after Post-acute Care at Different Settings: Estimation using the Propensity Score Matching Method

Li J, Daldalian MC, Erdmann C, Hunter KG, Sutariya B and Leung R

Objective: This study examines the relative risk of hospital readmission for patients receiving post-acute care (PAC) at different health care settings by utilizing an innovative big-data approach.

Study design: The electronic health records of 124, 127 patients from a large-scale health care system are extracted to allow for propensity score (PS) matching. The PS method is able to put patients into matched pairs, which became the unit of analysis in computing the odds ratios (OR) of hospital readmission for patients having received PAC at 5 different settings-home, home health agency (HHA), skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and long term care hospital (LTCH). The PS matching method controlled the effects of a large number of confounding variables, and computed the odd ratios of hospital readmission for patients at different PAC settings.

Results: We obtained mixed results regarding the odds ratios of hospital readmission for PAC settings in comparison with home care. While PAC patients at IRF and LTCH had a lower OR of hospital readmission than home care (0.77 and 0.76, respectively), PAC patients at HHA and SNF had a higher OR of hospital readmission (1.26 and 1.25, respectively). These results are statistically significant at p<0.05.

Conclusions: This research demonstrates an innovate approach to utilize EHR data for improving population health. Our findings call for rigorous techniques to improve care coordination specifically for PAC patients at institutional settings. Improved PAC coordination is able to reduce health care cost, and improve quality of health care delivery.