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

Details

• Alternative Title:
  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:
  Diabetes Care Health Reform Natural Experiments Readmissions State Health Policy
• Source:
  Med Care. 58(Suppl 6 1):S22-S30
• Pubmed ID:
  32412950
• Pubmed Central ID:
  PMC7324298
• Document Type:
  Journal Article
• Funding:
  T32 HS022241/HS/AHRQ HHSUnited States/ ; U18 DP006123/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  58
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ca16b056885ce6874378eeb1244bb7b92011c2868fdd1b96b2f2029073d27701
• Download URL:
  https://stacks.cdc.gov/view/cdc/90012/cdc_90012_DS1.pdf
• File Type:
  [PDF - 533.11 KB ]