Siddhartha Singh, MD, MS; James S. Goodwin, MD; Jie Zhou, PhD; Yong-Fang Kuo, PhD; Ann B. Nattinger, MD, MPH
Grant Support: By grants AG033134, K05CA134923, P30AG024832, and UL1TR001439 from the National Institutes of Health.
Disclosures: Dr. Singh reports personal fees from AstraZeneca outside the submitted work. Dr. Goodwin reports grants from the National Institutes of Health during the conduct of the study. Dr. Nattinger reports grants from the National Institutes of Health during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2526.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Zhou (e-mail, firstname.lastname@example.org). Data set: The analytic data set is restricted by a data use agreement with CMS that precludes sharing.
Corresponding Author: Siddhartha Singh, MD, MS, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226; e-mail, email@example.com.
Current Author Addresses: Drs. Singh and Nattinger: Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226.
Drs. Goodwin, Zhou, and Kuo: University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0177.
Author Contributions: Conception and design: S. Singh, J.S. Goodwin, Y.F. Kuo, A.B. Nattinger.
Analysis and interpretation of the data: S. Singh, J.S. Goodwin, J. Zhou, Y.F. Kuo, A.B. Nattinger.
Drafting of the article: S. Singh, J.S. Goodwin.
Critical revision of the article for important intellectual content: S. Singh, J.S. Goodwin, Y.F. Kuo, A.B. Nattinger.
Final approval of the article: S. Singh, J.S. Goodwin, J. Zhou, Y.F. Kuo, A.B. Nattinger.
Statistical expertise: J. Zhou, Y.F. Kuo.
Obtaining of funding: S. Singh, J.S. Goodwin.
Administrative, technical, or logistic support: S. Singh, J. Zhou.
Whether readmission rates vary by primary care physician (PCP) is unknown, although federal policy holds PCPs accountable for reducing readmissions.
To determine whether 30-day readmission rates vary by PCP.
Retrospective cohort study using marginal models and multilevel logistic regression with 100% of data on Texas Medicare claims from 2008 to 2015.
Patients discharged alive between 1 January 2008 and 30 November 2015 who had a PCP in the prior year and whose PCP had at least 50 admissions in the study period.
Readmission within 30 days of discharge. Follow-up visits with a PCP within 7 days of discharge were also measured.
Between 2012 and 2015, the mean risk-standardized rate of 30-day readmissions was 12.9%. Of 4230 PCPs, 1 had a readmission rate that was significantly higher than the mean and none had a significantly lower rate. The 10th and 90th percentiles of PCP readmission rates were 12.4% and 13.4%, respectively, each only 0.5 percentage point different from the mean. The 99th percentile of PCP readmission rates was 14.0%, 1.1 percentage points higher than the mean. Detecting a 1.1–percentage point difference from the mean adjusted readmission rate would require more than 3500 admissions per PCP per year.
Only fee-for-service Medicare patients in a single state were included. The authors could not account for confounders not included in Medicare databases or classify readmissions as avoidable.
Variation in readmission rates among PCPs is very low. Programs holding PCPs accountable for readmissions may prove ineffective.
National Institutes of Health.
Singh S, Goodwin JS, Zhou J, et al. Variation Among Primary Care Physicians in 30-Day Readmissions. Ann Intern Med. 2019;170:749–755. [Epub ahead of print 21 May 2019]. doi: 10.7326/M18-2526
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Published: Ann Intern Med. 2019;170(11):749-755.
Published at www.annals.org on 21 May 2019
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