The Early Impact of the CMS State Innovation Models Initiative on 30-Day Hospital Readmissions among Adults with Diabetes

Details

• Journal Article:
  Med Care
• Personal Author:
  Rodríguez, Hector P ; Fulton, Brent D ; Phillips, Aryn Z
• Description:
  Background ; The Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) Initiative funds states to accelerate delivery system and payment reforms. All SIM states focus on improving diabetes care, but SIM’s effect on 30-day readmissions among adults with diabetes remains unclear. ; Methods ; A quasi-experimental research design estimated the impact of SIM on 30-day hospital readmissions among adults with diabetes in three Round 1 SIM states (N=671,996) and three comparison states (N=2,719,603) from 2010–2015. Difference-in-differences (DID) multivariable logistic regression models that incorporated four-group propensity score weighting were estimated. Heterogeneity of SIM effects by grantee state and for CMS populations were assessed. ; Results ; In adjusted DID analyses, SIM was associated with an increase in odds of 30-day hospital readmission among patients in SIM states in the post- versus pre-SIM period relative to the ratio in odds of readmission among patients in the comparison states post- versus pre-SIM (ratio of aOR=1.057, p=0.01). Restricting the analyses to CMS populations (Medicare and Medicaid beneficiaries), resulted in consistent findings (ratio of aOR= 1.057, p=0.034). SIM did not have different effects on 30-day readmissions by state. ; Conclusions ; We found no evidence that SIM reduced 30-day readmission rates among adults with diabetes during the first 2 years of Round 1 implementation, even among CMS beneficiaries. It may be difficult to reduce readmissions statewide without greater investment in health information exchange and more intensive use of payment models that promote interorganizational coordination.
• Subjects:
  • Centers for Medicare and Medicaid Services, U.S.
  • Diabetes Mellitus
  • Humans
  • Logistic Models
  • Models, Organizational
  • Organizational Innovation
  • Patient Readmission
  • Propensity Score
  • Quality Improvement
  • United States
• Keywords:
  • state health policy
  • natural experiments
  • diabetes care
  • readmissions
  • health reform
• Source:
  Med Care. 58(Suppl 6 1):S22-S30
• DOI:
  http://dx.doi.org/10.1097/MLR.0000000000001276
• Pubmed ID:
  32412950
• Pubmed Central ID:
  PMC7324298
• Document Type:
  Text ; Journal Article
• Funding:
  T32 HS022241/HS/AHRQ HHSUnited States/ ; U18 DP006123/DP/NCCDPHP CDC HHSUnited States/
• Genre:
  Journal Article
• Volume:
  58
• Download URL:
  https://stacks.cdc.gov/view/cdc/90012/cdc_90012_DS1.pdf
• File Type:
  [PDF - 533.11 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:8f5c03ec395113a8cd14bea7a23932f3c30311b6d6932a1c6a72b782ef3ce21e0a9da50f34d3fff7cac0f39a135ac60dd1efd56b51615c1b32edce34af6b0ad5