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BMJ Publishing Group, BMJ Open, 2(8), p. e018164, 2018

DOI: 10.1136/bmjopen-2017-018164

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Did case-based payment influence surgical readmission rates in France? A retrospective study

This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

ObjectivesTo determine whether implementation of a case-based payment system changed all-cause readmission rates in the 30 days following discharge after surgery, we analysed all surgical procedures performed in all hospitals in France before (2002–2004), during (2005–2008) and after (2009–2012) its implementation.SettingOur study is based on claims data for all surgical procedures performed in all acute care hospitals with >300 surgical admissions per year (740 hospitals) in France over 11 years (2002–2012; n=51.6 million admissions).InterventionsWe analysed all-cause 30-day readmission rates after surgery using a logistic regression model and an interrupted time series analysis.ResultsThe overall 30-day all-cause readmission rate following discharge after surgery increased from 8.8% to 10.0% (P<0.001) for the public sector and from 5.9% to 8.6% (P<0.001) for the private sector. Interrupted time series models revealed a significant linear increase in readmission rates over the study period in all types of hospitals. However, the implementation of case-based payment was only associated with a significant increase in rehospitalisation rates for private hospitals (P<0.001).ConclusionIn France, the increase in the readmission rate appears to be relatively steady in both the private and public sector but appears not to have been affected by the introduction of a case-based payment system after accounting for changes in care practices in the public sector.