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Post-Acute Care

Medicare patients over age 65 are admitted to the hospital over nine million times annually. Almost one in five of these patients are readmitted within a month of discharge. These readmissions are often a sign of inadequate discharge planning, poor care coordination between hospital and community clinicians, and the lack of effective longitudinal community-based care. The additional hospital stays imply that many patients are getting sicker, not better, after their initial discharge. Other patients are readmitted simply because they live in a locale where the hospital is used more frequently as a site of care. The recognition of hospitals' central role in patients' care has grown during the past two decades along with the evidence that many patients do not do well after hospital discharge.

The data in this category show variation in the care of Medicare patients after they are discharged from the hospital. Several important aspects of post-discharge care are featured, including 30-day readmission rates, the percent of patients visiting a primary care clinician or any clinician within two weeks after discharge, and the percent having an emergency room visit within 30 days. To help understand the extent of problems with discharge planning and care coordination, we examined six Medicare patient populations: those discharged for medical conditions, for surgical conditions, for hip fracture, and for three common causes of medical hospitalization -- congestive heart failure, heart attacks and pneumonia.

The study population consists of 100% of fee-for-service Medicare beneficiaries who resided in the 306 Dartmouth Atlas hospital referral regions and had full Part A (acute care in facilities, including hospitals) and Part B (clinician services) coverage during the study periods. Beneficiaries had to be age 65 or older on July 1, 2003 for Time 1 (2004) and on July 1, 2008 (2009) for Time 2. Persons enrolled in managed care organizations were excluded from the analyses. For each study period, we first identified hospital claims from short-term acute or critical access hospitals among the study population for each cohort. We excluded cohort hospitalizations with the discharge status on the claim indicating expired (died in the hospital), left against medical advice or discharged to hospice. For the remaining cohort hospitalization records, we excluded hospitalizations when the patient had any acute care hospitalizations in the 90 days prior to cohort admission date. Transfers (defined as (1) within one-day transfer, (2) both stays had the same cohort event, and (3) both indicated transfer status) were considered as a single cohort hospitalization. For each study period, only one cohort hospitalization (index hospitalization) was selected for each patient for each cohort (we randomly selected one if more than one hospitalization met the criteria). We further excluded index hospitalizations with the discharge status field indicating another acute care hospitals that did not meet the transfer criteria. For more information, please see the Methods section of our report "After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries."

Measures based on a count of fewer than 11 patients are not displayed for reasons of patient confidentiality. Rates with fewer than 26 expected events are also suppressed because of a lack of statistical precision. These cells are marked "na."




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The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation, including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.