Reducing Hospital Readmissions in the Wake of the Affordable Care Act: Focus on Transition of Care and Social Determinants

Abstract

Preventable thirty-day hospital readmissions are an indicator of poor quality of care and a major contributor to health care costs. In response, the Affordable Care Act (ACA) implemented programs such as the Hospital Readmissions Reduction Program (HRRP) and the Community-based Care Transitions Program (CCTP) to reduce hospital readmissions. Health care providers and acute care hospitals, in particular, are presented with clear incentives to reduce readmissions in order to avoid the HRRP’s financial penalties, and to innovate readmission reduction programs at little to no expense through CCTP funding. However, the specific steps to reduce readmissions are not as clear. To better understand how to reduce readmissions, this thesis examines patients’ transition of care and social determinants as two factors that may contribute to hospital readmission. Using the UCLA Health System as a case study, the analysis first quantitatively tests the hypothesis that transition of care is associated with hospital readmission, and that social determinants confound that relationship. Then a qualitative analysis incorporating the perspectives of stakeholders at all stages of a patient’s transition of care process offers insight into the mechanisms behind the quantitative results. By integrating quantitative and qualitative interpretations, the results show that transition of care is associated with both social determinants and hospital readmission. Furthermore, readmission reduction programs in the UCLA Health System that directly improve transition of care are associated with reduced odds of readmission. These findings contribute to the current health care landscape and the existing literature examining readmissions. At the hospital level, other hospitals can learn from the successes at UCLA, adapting UCLA’s readmission reduction programs to their own unique environments and health systems. At the national level, the findings support a continued, perhaps even increased, policy focus on targeting transition of care as the key factor contributing to hospital readmission, while addressing social determinants as a confounding factor.