Siddique SM, et al. - The target of the experts was to investigate the quality and value based on rates of hospital readmission and to characterize heterogeneity in outcomes of subgroups of patients with gastrointestinal bleeding. It was discovered that 16% of such patients were readmitted to the hospital, as per the retrospective analysis of Medicare fee for service beneficiaries hospitalized for gastrointestinal bleeding. Variation was observed in the rates of hospital readmission, length of stay, and mortality with the type of gastrointestinal bleeding. Nonetheless, Medicare Severity Diagnosis Related Groups (MS-DRGs) accounted for the largest source of variation. Data displayed that policies targeting the quality and value ought to account for this heterogeneity.

Methods

• A cross-sectional, claims-based retrospective analysis was carried out of Medicare fee for service beneficiaries hospitalized for gastrointestinal bleeding in 2014 (159,000 hospitalizations).
• The primary outcome included unplanned readmission within 30 days of discharge from the hospital (30-day readmission).
• Length of stay, inpatient mortality, and death within 30 days of admission to the hospital (30-day mortality) served as the secondary outcomes.
• Analyses were adjusted for age, sex, race, and Elixhauser comorbidities using logistic and Poisson regression, adjusting for clustering within hospitals.

Results

• It was determined that the 30-day readmission rate was 16.0%.
• Variation was found in the readmission rates among patients with different types of gastrointestinal bleeding, ranging from 13.5% for diverticular bleeding to 18.6% for small bowel bleeding.
• As per the results, the mean length of stay was 4.2 days and 30-day mortality was 6.9% (ranging from 3.4% for diverticular bleeding to 12.1% for upper gastrointestinal bleeding not otherwise specified).
• Findings exhibited that the main source of variation in rates of readmission and mortality was MS-DRGs when hospitalizations were stratified by MS-DRGs.