PMID- 33543477
OWN - NLM
STAT- MEDLINE
DCOM- 20211203
LR  - 20220716
IS  - 1475-6773 (Electronic)
IS  - 0017-9124 (Print)
IS  - 0017-9124 (Linking)
VI  - 56
IP  - 3
DP  - 2021 Jun
TI  - Development of claims-based measures of unplanned acute care with superior power 
      for assessing the effectiveness of interventions following acute care.
PG  - 550-557
LID - 10.1111/1475-6773.13617 [doi]
AB  - OBJECTIVE: To develop outcome measures that are more sensitive than current 
      measures for evaluating primary or transitional care after hospitalizations, 
      emergency department (ED) visits, or observation stays. DATA SOURCES: Medicare 
      claims data from January 1, 2015, to October 31, 2017, for 1 261 707 Medicare 
      fee-for-service beneficiaries served by (a) primary care practices participating 
      in Track 1 of the Comprehensive Primary Care Plus (CPC+) initiative, and (b) 
      their matched comparison practices. STUDY DESIGN: Given the poor statistical 
      power in many studies to detect effects on readmissions, we developed two novel 
      claims-based measures of unplanned acute care (UAC) following an index acute care 
      event. The first measure assesses the proportion of hospitalizations followed by 
      an unplanned readmission, ED visit, or observation stay within 30 days of 
      discharge; the second assesses the proportion of ED visits and observation stays 
      followed by a hospitalization, ED visit, or observation stay within 30 days. We 
      calculate minimum detectable effects (MDEs) for both measures and for a 
      conventional measure of 30-day unplanned readmissions, using CPC+ data. PRINCIPAL 
      FINDINGS: Repeat UAC events are common among Medicare beneficiaries served by the 
      CPC+ practices. In 2017, 22% of discharges and 21% of ED visits and observation 
      stays had a UAC event within 30 days. Readmissions were the most common UAC event 
      following discharge, whereas ED visits were most common following index ED visits 
      or observation stays. MDEs are 25%-40% lower for the new measures than for the 
      standard 30-day readmissions measure, indicating better statistical power to 
      detect impacts of primary or transitional care interventions. CONCLUSIONS: This 
      study introduces two new claims-based measures to assess quality of care during a 
      patient's vulnerable period following acute care. The new measures complement 
      existing measures, covering a broader range of UAC events than the standard 
      30-day readmissions measure, and yielding greater statistical power.
CI  - (c) 2021 Health Research and Educational Trust.
FAU - Chen, Arnold Y
AU  - Chen AY
AUID- ORCID: 0000-0002-8065-4025
AD  - Mathematica, Princeton, New Jersey, USA.
FAU - Blue, Laura
AU  - Blue L
AUID- ORCID: 0000-0002-1634-2692
AD  - Mathematica, Washington, DC, USA.
FAU - Tilipman, Jason
AU  - Tilipman J
AD  - Mathematica, Princeton, New Jersey, USA.
FAU - McCall, Nancy
AU  - McCall N
AD  - Mathematica, Washington, DC, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20210204
PL  - United States
TA  - Health Serv Res
JT  - Health services research
JID - 0053006
SB  - IM
MH  - Comprehensive Health Care/*statistics & numerical data
MH  - Continuity of Patient Care/*statistics & numerical data
MH  - Emergency Service, Hospital/statistics & numerical data
MH  - Fee-for-Service Plans
MH  - Humans
MH  - Insurance Claim Review/statistics & numerical data
MH  - Medicare/*statistics & numerical data
MH  - Patient Readmission/statistics & numerical data
MH  - Primary Health Care/*statistics & numerical data
MH  - *Treatment Outcome
MH  - United States
PMC - PMC8143701
OTO - NOTNLM
OT  - Medicare
OT  - acute inpatient care
OT  - administrative data uses
OT  - ambulatory/outpatient care
OT  - hospitals
OT  - primary care
OT  - program evaluation
OT  - quality of care/patient safety (measurement)
EDAT- 2021/02/06 06:00
MHDA- 2021/12/15 06:00
PMCR- 2022/06/01
CRDT- 2021/02/05 06:06
PHST- 2021/02/06 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2021/02/05 06:06 [entrez]
PHST- 2022/06/01 00:00 [pmc-release]
AID - HESR13617 [pii]
AID - 10.1111/1475-6773.13617 [doi]
PST - ppublish
SO  - Health Serv Res. 2021 Jun;56(3):550-557. doi: 10.1111/1475-6773.13617. Epub 2021 
      Feb 4.