Predicting Hospital Readmission in Medicaid Patients With Diabetes Using Administrative and Claims Data.

J Yun, G Filardo, V Ahuja, ME Bowen… - American Journal of …, 2023 - search.ebscohost.com
American Journal of Managed Care, 2023search.ebscohost.com
OBJECTIVES: Readmission is common and costly for hospitalized Medicaid patients with
diabetes. We aimed to develop a model predicting risk of 30-day readmission in Medicaid
patients with diabetes hospitalized for any cause. STUDY DESIGN: Using 2016-2019
Medicaid claims from 7 US states, we identified patients who (1) had a diagnosis of diabetes
or were prescribed any diabetes drug,(2) were hospitalized for any cause, and (3) were
discharged to home or to a nonhospice facility. For each encounter, we assessed whether …
Abstract
OBJECTIVES: Readmission is common and costly for hospitalized Medicaid patients with diabetes. We aimed to develop a model predicting risk of 30-day readmission in Medicaid patients with diabetes hospitalized for any cause. STUDY DESIGN: Using 2016-2019 Medicaid claims from 7 US states, we identified patients who (1) had a diagnosis of diabetes or were prescribed any diabetes drug,(2) were hospitalized for any cause, and (3) were discharged to home or to a nonhospice facility. For each encounter, we assessed whether the patient was readmitted within 30 days of discharge. METHODS: Applying least absolute shrinkage and selection operator variable selection, we included demographic data and claims history in a logistic regression model to predict 30-day readmission. We evaluated model fit graphically and measured predictive accuracy by the area under the receiver operating characteristic curve (AUROC). RESULTS: Among 69,640 eligible patients, there were 129,170 hospitalizations, of which 29,410 (22.8%) were 30-day readmissions. The final model included age, sex, age-sex interaction, past diagnoses, US state of admission, number of admissions in the preceding year, index admission type, index admission diagnosis, discharge status, length of stay, and length of stay--sex interaction. The observed vs predicted plot showed good fit. The estimated AUROC of 0.761 was robust in analyses that assessed sensitivity to a range of model assumptions. CONCLUSIONS: Our model has moderate power for identifying hospitalized Medicaid patients with diabetes who are at high risk of readmission. It is a template for identifying patients at risk of readmission and for adjusting comparisons of 30-day readmission rates among sites or over time.
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