Does a complex care discharge planning initiative reduce unplanned hospital readmissions?

Project number: 
17-200
Approval date: 
Monday, April 23, 2018
Principal Investigator: 
Staples,John
Institution: 
University of British Columbia (UBC)
Funding Agency: 
Providence Health Care Research Institute and Vancouver Coastal Health Research Institute,Specialist
Datasets requested: 
PharmaNet
consolidation - census geocodes
MSP Practitioner File
Deaths (BC Vital Statistics Agency)
Hospital Separations (BC Ministry of Health)
Consolidation file (BC Ministry of Health)
Income band (Statistics Canada)
Medical Services Plan (BC Ministry of Health)
Consolidation - demographic (Ministry of Health)
Research objective: 

Research questions:

A) At a population level, did the G78717 policy decrease the risk of unplanned hospital readmission?
B) At the level of the individual, does exposure to the G78717 intervention bundle decrease the risk of unplanned hospital readmission?
C) Did the G78717 policy improve key secondary outcomes that might have been improved by improved coordination of care (namely mortality, health services use, an prescription of appropriate medications)?
D) To what extend was the G78717 policy a cost-effective policy intervention?

Hypotheses:

The interrupted time series analysis has two primary hypotheses:
-Hypothesis 1: Among the population of eligible hospitalizations, implementation of the Specialist Discharge Care Plan for Complex Patient fee code (G78717; $75) policy was associated with a reduction in the monthly risk of unplanned hospital readmission within 30 days of discharge.
-Hypothesis 2: At a population level, the cost savings estimated to result from avoided readmissions exceeds the total cost of G78717 fee code payments.

The cohort analysis has two primary hypotheses:
-Hypothesis 3: Compared to the control group, hospitalizations with payment of the Specialist Discharge Care Plan for Complex Patient fee code (G78717; $75) are associated with a reduced risk of hospital readmission within 30 days of index hospital discharge.
-Hypothesis 4: The cost savings estimated to result from avoided readmissions exceeds the cost of the financial incentive payment.

Objectives:

1) To determine if there was a temporal change in provincial readmission rates associated with the implementation of the new fee code.
2) To determine if patients exposed to this fee code (and thus likely exposed to the interventions it required) had a lower risk of unplanned hospital readmission than patients who were not exposed to this fee code.
3) To determine if key secondary outcomes were influenced by the implementation of the new fee code.
4) To determine, at the level of the healthcare system, the amount of the financial incentive relative to the cost avoidance of readmissions.


Page last revised: June 5, 2018