In addition to the patient-level discharge severity score, hospital-level predictors were included in a hierarchical logistic regression model to estimate systematic and random variability in rates of PASU across hospitals (Gatsonis et al.
For patients within each hospital, the discharge severity score was related to the probability of PASU using logistic regression.
In particular, the proportion of individuals age 80 or over was greater in those with PASU than those without (40 versus 21 percent).
The overall rate of PASU across States varied from 31 percent in Ohio to 44 percent in Massachusetts.
The patient discharge severity score had a large, significant association with PASU (OR=2.
This exploratory study is one of the first to characterize and compare the distribution of PASU in AMI patients immediately following discharge.
This study does not clarify the association between for-profit ownership of the discharging hospital and increased PASU.
The finding of a significant, positive association between the provision of home health services by the discharging hospital and PASU also suggests the importance of the organizational structure of hospitals in influencing patterns of service use.
In general, patient characteristics were more important predictors of PASU than hospital factors.
Geographical variation in PASU was quite broad, on both an individual hospital and regional basis.
Given the variations in PASU across States for elderly AMI patients, the potential for differential impacts of the post-acute payment policies mandated by the BBA warrants discussion.
In general, rates of PASU for AMI patients were similar to those reported for all Medicare beneficiaries, but lower than those according several major disease categories.