Table 2.
Results of Multivariable Models of Pooled Thirty-Day Risk-Standardized Readmission Rates for 4,073 Hospitals in 2,244 Counties; Main Results (without Hospital Characteristics) and Sensitivity Analysis (with Hospital Characteristics)
| Without Hospital Characteristics | With Hospital Characteristics | |||||
|---|---|---|---|---|---|---|
| Coefficient* (95% CI) | p | Wald p† | Coefficient* (95% CI) | p | Wald p† | |
| Intercept | 20.11 (19.56, 20.65) | 20.35 (19.78, 20.92) | ||||
| Demographic factors | ||||||
| % Residents never married | <.001 | <.001 | ||||
| 1st quintile | ref‡ | ref | ||||
| 2nd quintile | −0.11 (−0.32, 0.11) | .33 | −0.14 (−0.35, 0.08) | .22 | ||
| 3rd quintile | 0.05 (−0.17, 0.27) | .67 | 0.09 (−0.13, 0.31) | .44 | ||
| 4th quintile | 0.16 (−0.07, 0.38) | .17 | 0.18 (−0.04, 0.41) | .11 | ||
| 5th quintile | 0.42 (0.18, 0.66) | <.001 | 0.50 (0.26, 0.74) | <.001 | ||
| Medicare beneficiaries/100k | <.001 | <.001 | ||||
| 1st quintile | ref | ref | ||||
| 2nd quintile | 0.10 (−0.08, 0.29) | .27 | 0.15 (−0.04, 0.33) | .12 | ||
| 3rd quintile | 0.37 (0.16, 0.58) | <.001 | 0.35 (0.13, 0.56) | .00 | ||
| 4th quintile | 0.58 (0.36, 0.81) | <.001 | 0.52 (0.30, 0.75) | <.001 | ||
| 5th quintile | 0.56 (0.30, 0.82) | <.001 | 0.53 (0.27, 0.79) | <.001 | ||
| Low education§ | ||||||
| No | ref | ref | ||||
| Yes | 0.72 (0.54, 0.91) | <.001. | 0.41 (0.21, 0.61) | <.001 | ||
| Retirement destination§ | ||||||
| No | ref | ref | ||||
| Yes | −0.32 (−0.51, −0.13) | <.001 | −0.25 (−0.44, −0.06) | .01 | ||
| Rural/urban continuum | ||||||
| Large central metro | ref | <.001 | ref | <.001 | ||
| Large fringe metro | 0.16 (−0.14, 0.47) | .29 | 0.15 (−0.15, 0.46) | .33 | ||
| Medium metro | −0.58 (−0.88, −0.28) | <.001 | −0.68 (−0.98, −0.38) | <.001 | ||
| Small metro | −0.72 (−1.04, −0.41) | <.001 | −0.89 (−1.21, −0.58) | <.001 | ||
| Micropolitan | −0.52 (−0.84, −0.19) | .002 | −0.70 (−1.02, −0.37) | <.001 | ||
| Rural | −0.58 (−0.94, −0.22) | .002 | −0.64 (−1.01, −0.28) | <.001 | ||
| Access to care | ||||||
| Nursing homes/100k | .001 | |||||
| 1st quintile | ref | ref | .011 | |||
| 2nd quintile | 0.08 (−0.10, 0.25) | .39 | 0.10 (−0.08, 0.27) | .27 | ||
| 3rd quintile | −0.04 (−0.23, 0.16) | .71 | −0.04 (−0.24, 0.15) | .67 | ||
| 4th quintile | −0.15 (−0.38, 0.07) | .18 | −0.13 (−0.36, 0.10) | .26 | ||
| 5th quintile | −0.48 (−0.75, −0.20) | <.001 | −0.37 (−0.65, −0.09) | .01 | ||
| GPs/100k | <.001 | <.001 | ||||
| 1st quintile | ref | ref | ||||
| 2nd quintile | −0.39 (−0.58, −0.19) | <.001 | −0.34 (−0.54, −0.15) | <.001 | ||
| 3rd quintile | −0.49 (−0.71, −0.28) | <.001 | −0.43 (−0.64, −0.21) | <.001 | ||
| 4th quintile | −0.72 (−0.96, −0.48) | <.001 | −0.59 (−0.83, −0.35) | <.001 | ||
| 5th quintile | −0.80 (−1.09, −0.51) | <.001 | −0.63 (−0.92, −0.34) | <.001 | ||
| Specialists/100k | .006 | |||||
| 1st quintile | ref | ref | .004 | |||
| 2nd quintile | 0.46 (0.18, 0.73) | .001 | 0.37 (0.09, 0.65) | .01 | ||
| 3rd quintile | 0.76 (0.41, 1.11) | <.001 | 0.71 (0.35, 1.06) | <.001 | ||
| 4th quintile | 0.78 (0.37, 1.19) | <.001 | 0.76 (0.35, 1.17) | <.001 | ||
| 5th quintile | 0.70 (0.22, 1.17) | .004 | 0.77 (0.29, 1.25) | .002 | ||
| GPS/specialist | <.001 | <.001 | ||||
| 1st quintile | ref | ref | ||||
| 2nd quintile | −0.26 (−0.46, −0.06) | .009 | −0.27 (−0.47, −0.07) | .01 | ||
| 3rd quintile | −0.27 (−0.54, −0.01) | .04 | −0.26 (−0.53, 0.00) | .05 | ||
| 4th quintile | −0.05 (−0.42, 0.31) | .77 | −0.02 (−0.38, 0.35) | .93 | ||
| 5th quintile | 0.30 (−0.20, 0.80) | .23 | 0.33 (−0.17, 0.84) | .19 | ||
| Beds/100k | <.001 | .240 | ||||
| 1st quintile | ref | ref | ||||
| 2nd quintile | 0.07 (−0.13, 0.27) | .52 | −0.04 (−0.24, 0.17) | .72 | ||
| 3rd quintile | 0.11 (−0.10, 0.32) | .31 | −0.11 (−0.33, 0.10) | .31 | ||
| 4th quintile | 0.41 (0.19, 0.63) | <.001 | 0.09 (−0.14, 0.32) | .46 | ||
| 5th quintile | 0.51 (0.27, 0.74) | <.001 | 0.05 (−0.20, 0.31) | .68 | ||
| Nursing home quality | ||||||
| % High-risk long-stay patients with pressure sores | <.001 | <.001 | ||||
| 1st quintile | ref | ref | ||||
| 2nd quintile | 0.17 (−0.03, 0.37) | .10 | 0.11 (−0.09, 0.31) | .29 | ||
| 3rd quintile | 0.24 (0.04, 0.44) | .02 | 0.17 (−0.03, 0.37) | .09 | ||
| 4th quintile | 0.48 (0.28, 0.69) | <.001 | 0.40 (0.19, 0.61) | <.001 | ||
| 5th quintile | 0.92 (0.71, 1.13) | <.001 | 0.83 (0.61, 1.04) | <.001 | ||
| % Long-stay patients depressed or anxious | <.001 | .013 | ||||
| 1st quintile | ref | ref | ||||
| 2nd quintile | −0.17 (−0.36, 0.01) | .07 | −0.11 (−0.30, 0.07) | .24 | ||
| 3rd quintile | −0.24 (−0.43, −0.05) | .02 | −0.14 (−0.33, 0.06) | .16 | ||
| 4th quintile | −0.31 (−0.51, −0.11) | .002 | −0.21 (−0.41, −0.01) | .04 | ||
| 5th quintile | −0.53 (−0.75, −0.32) | <.001 | −0.38 (−0.60, −0.17) | <.001 | ||
| % Long-stay patients whose need for help has increased | ||||||
| 1st quintile | ref | .002 | ref | .001 | ||
| 2nd quintile | 0.28 (0.09, 0.47) | .003 | 0.32 (0.13, 0.51) | <.001 | ||
| 3rd quintile | 0.07 (−0.12, 0.25) | .50 | 0.08 (−0.11, 0.27) | .40 | ||
| 4th quintile | 0.08 (−0.11, 0.27) | .42 | 0.08 (−0.11, 0.27) | .43 | ||
| 5th quintile | 0.33 (0.12, 0.53) | .002 | 0.32 (0.11, 0.52) | .002 | ||
| Hospital characteristics | ||||||
| Ownership | ||||||
| Public | ref | <.001 | ||||
| Private not for profit | 0.08 (−0.04, 0.21) | .20 | ||||
| Private for profit | 0.54 (0.38, 0.70) | <.001 | ||||
| Teaching status | ||||||
| None | ref | <.001 | ||||
| Residency | −0.20 (−0.33, −0.07) | .002 | ||||
| COTH | 0.34 (0.17, 0.50) | <.001 | ||||
| Beds | ||||||
| ≤50 | ref | <.001 | ||||
| 51–100 | 0.28 (0.10, 0.45) | .003 | ||||
| 101–200 | 0.51 (0.32, 0.69) | <.001 | ||||
| 201–300 | 0.48 (0.28, 0.69) | <.001 | ||||
| 301+ | 0.37 (0.15, 0.58) | <.001 | ||||
| Safety-net hospital | ||||||
| No | ref | |||||
| Yes | 0.14 (0.01, 0.27) | .04 | ||||
| Patient socioeconomic status | ||||||
| 1st quintile | ref | <.001 | ||||
| 2nd quintile | −0.26 (−0.43, −0.10) | .001 | ||||
| 3rd quintile | −0.66 (−0.83, −0.50) | <.001 | ||||
| 4th quintile | −0.73 (−0.91, −0.55) | <.001 | ||||
| 5th quintile | −0.99 (−1.19, −0.80) | <.001 | ||||
*
Change in pooled risk-standardized readmission rate.
†
Overall p-value based on Wald-test.
‡
Ref = Reference category, omitted from model.
§
County classification from the Department of Agriculture.