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Health services research
Research
Did case-based payment influence surgical readmission rates in France? A retrospective study
  1. Albert Vuagnat1,2,
  2. Engin Yilmaz2,3,
  3. Adrien Roussot1,
  4. Victor Rodwin4,
  5. Maryse Gadreau5,
  6. Alain Bernard6,
  7. Catherine Creuzot-Garcher7,8,
  8. Catherine Quantin1,9,10
  1. 1 Department of Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
  2. 2 Division of Research and Statistics, Ministry of Health, Paris, France
  3. 3 School of Economics, University of Sorbonne, Paris, France
  4. 4 The Robert F. Wagner School of Public Service, New York University, New York, USA
  5. 5 Laboratoire d’Economie de Dijon, Université Bourgogne/Franche-Comté, Inserm U1200, CNRS UMR 6307, Dijon, France
  6. 6 Department of Thoracic Surgery, University Hospital, Dijon, France
  7. 7 Department of Ophthalmology, University Hospital, Dijon, France
  8. 8 Eye and Nutrition Research Group, Bourgogne Franche-Comté University, Dijon, France
  9. 9 Clinical Investigation Center, Dijon University Hospital, Dijon, France
  10. 10 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
  1. Correspondence to Dr Catherine Quantin; catherine.quantin{at}chu-dijon.fr

Abstract

Objectives To 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.

Setting Our 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).

Interventions We analysed all-cause 30-day readmission rates after surgery using a logistic regression model and an interrupted time series analysis.

Results The 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).

Conclusion In 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.

  • surgery
  • readmissions
  • acute care
  • hospital reimbursement
  • inpatient care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-018164

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    Footnotes

    • Contributors AV and EY conceptualised and designed the study, interpreted the data and wrote the paper. AR contributed substantially to writing the manuscript. VR, MG, AB and CC-G participated in the interpretation of the results and reviewed and revised the manuscript drafts. CQ oversaw the data analysis and interpretation and contributed substantially to writing the manuscript. All authors accept responsibility for the paper as published.

    • Funding This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was approved by the National Committee for Data Protection (registration numbers: (a) 1576793; (b) 913291 for Dijon University Hospital and (c) 723116 for the Ministry of Health) and therefore was conducted in accordance with the Declaration of Helsinki. Written consent was not needed for this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.