A preliminary look at readmission and mortality among chronically critically ill and other medically complex Medicare patients

ABSTRACT

Chronically critically ill and other medically complex patients (CCI/MC-Ps) are those who are hospitalized with long-term intensive care needs and require extended periods of hospital-level care. CCI/MC-Ps may be at higher risk for readmission and mortality than other populations due to the severe nature their illnesses. This article examines factors that lead to increased probability of hospital readmission or mortality among CCI/MC Medicare patients. Logistic regression analyses are used to examine mortality and readmissions among the CCI/MC population. Numerous factors including length of stay in the acute hospital, age and gender affect whether a patient is readmitted to the acute care hospital within 90 days of discharge or dies within 60 days following a hospital stay.

KEYWORDS:

• Readmission
• mortality
• Medicare
• chronically critically ill

JEL CLASSIFICATOINS:

• I1
• I18

Acknowledgements

This analyses for this article were performed under Centers for Medicare and Medicaid Services Contract No. HHSM-500-2006-00081. Funding for this article received internal support from RTI International. The views and conclusions expressed in this article are those of the authors alone.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

¹ Kahn et al. (2013), Nelson et al. (2010), Wiencek and Winkelman (2010), Daly et al. (2009), Nierman and Nelson (2002).

² Nierman and Nelson (2002).

³ Kahn et al. (2009).

⁴ Nelson et al. (2006).

⁵ Thomas et al. (2002).

⁶ Consistent with prior work, e.g. Gage, Pilkauskas, and Dalton et al. (2007).

⁷ Reference group was discharged to home or hospice. Patients discharged to home or hospice may have utilized services not captured.

⁸ Facility coefficients were statistically significantly different from each other for PMV, sepsis and MOF. For wounds, IRF and SNF coefficients were not statistically different. For tracheostomy, LTCH and IRF coefficients were not statistically different.

⁹ Results available upon request.

Additional information

Funding

The analyses for this paper were performed under Centers for Medicare and Medicaid Services Contract No. HHSM-500-2006-00081. Funding for this paper came from internal support from RTI International. The views and conclusions expressed in this paper are those of the authors alone.