All ETDs from UAB

Advisory Committee Chair

Meredith L Kilgore

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

This dissertation is composed of two papers related to the role of social risk factors in the Hospital Readmissions Reduction Program (HRRP). As value-based initiatives like the HRRP become more commonplace, there is growing need to understand the relationship between performance in these programs and social risk factors, such as race and poverty, which are not incorporated in the program’s risk adjustment methodology. To address this gap in the literature, this dissertation specifically focuses on three areas: 1) how hospital and community factors are related to average HRRP penalties, taking the context of geography into account, 2) how hospital and community factors are related to HRRP penalties across the entire distribution, and 3) how levels and associations of these factors relate to the penalty differential between hospitals that serve low versus high proportions of dual-eligible patients. The first paper explores whether there is regional heterogeneity in how hospital and community factors are associated to average readmission penalties. Specifically, the paper investigates the potential for differential associations between these characteristics and penalties from hospitals belonging to different contexts (i.e., counties). The second paper expands on the first by examining how hospital and community factors relate to the entire distribution of HRRP penalties, beyond the mean. In addition, it decomposes differences in readmission penalties between hospitals that serve low versus high proportions of dual-eligible patients into 1) how much can be explained by differences in levels of social risk factors and 2) how much remains unexplained due to differences in the associations of those characteristics and readmission penalties.

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