Hughes, Kailey
(2017)
Influence of polypharmacy on 30-day readmission rates among Medicare recipients.
Master Essay, University of Pittsburgh.
Abstract
Background: As chronic diseases become increasingly treatable, the American population continues to experience longer lifespans. These longer lifespans place further burden on federally funded healthcare programs, including Medicare. Established by the Affordable Care Act, the Hospital Readmissions Reduction Program (HRRP) was created to address hospitals with excessive readmissions. The 30-day All-Cause Hospital Readmission measure objectively evaluates the level of care and identifies areas in need of improvement within hospitals. The goal of the measure is to provide better quality care to patients and reduce 30-day readmissions. In this study, we aimed to investigate the influence of polypharmacy on 30-day readmissions among Medicare patients.
Methods: Gateway Health Medicare members with at least one inpatient hospital discharge during 2016 was the target population for this investigation. To be included in the study, members were required to have been continuously enrolled in a Gateway Health Medicare plan for at least one year prior to their first admission, and for at least thirty days after being discharged. 9,414 Gateway Health Medicare members, including both disabled and aged beneficiaries, met the study eligibility requirements. Multivariate logistic regression analysis was used to determine the relationship between polypharmacy (concurrent use of 5 or more medication) and 30-day readmission, adjusting for age, race/ethnicity, gender, Significant Persistent Mental Illness (SPMI) flag, and the location the member was discharged to after the inpatient hospital admission.
Results: Polypharmacy use (OR 2.0, 95% CI 1.7 – 2.2), discharge to Home Healthcare (HHC) (OR: 1.4, 95% CI: 1.2, 1.6), discharge to Skilled Nursing Facility (SNF) (OR: 1.9, 95% CI: 1.7, 2.2), and a SPMI flag (OR: 1.9, 95% CI: 1.5, 2.4) were associated with a higher risk of 30-day readmission.
Conclusion: The results of this study indicate several characteristics which, in addition to polypharmacy, increase an individual’s risk of 30-day readmission. Polypharmacy individuals often have complex medical conditions and comorbidities which pose unique challenges to recovery. Addressing individuals’ medication burden prior to discharge, improving HHC, and expanding mental health services could lead to a reduction in 30-day readmissions in this vulnerable population. By focusing on a non-traditional barrier to care, hospitals can provide better care for their patients and improve public health in the surrounding communities.
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Details
| Item Type: |
Other Thesis, Dissertation, or Long Paper
(Master Essay)
|
| Status: |
Published |
| Creators/Authors: |
|
| Contributors: |
| Contribution | Contributors Name | Email | Pitt Username | ORCID  |
|---|
| Committee Chair | Haggerty, Catherine | haggertyc@edc.pitt.edu | UNSPECIFIED | UNSPECIFIED | | Committee Member | Donohue, Julie | donohuej@pitt.edu | UNSPECIFIED | UNSPECIFIED | | Committee Member | Marshall, Lynne | lmarshall@gatewayhealthplan.com | UNSPECIFIED | UNSPECIFIED |
|
| Date: |
15 December 2017 |
| Date Type: |
Submission |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
31 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
MPH - Master of Public Health |
| Thesis Type: |
Master Essay |
| Refereed: |
Yes |
| Date Deposited: |
17 Jul 2018 15:53 |
| Last Modified: |
01 Jan 2021 06:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/33424 |
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