Reducing readmissions by addressing the social determinants of health

Abstract

Hospital readmissions generate enormous costs and are the subject of increased scrutiny among US lawmakers. The Affordable Care Act created the Community-Based Care Transitions Program (CCTP) to test models for improving care transitions after hospital discharge with the goal of reducing 30-day Medicare hospital readmission rates by 20 percent. Few of these demonstrations showed sustained reductions in readmission rates. In contrast to more traditional medically focused programs, the Chicago Southland Coalition for Transition Care (CSCTC) utilized social workers solely to manage care transitions in an effort to address nonmedical obstacles to recovery. Using a difference-in-differences model and the census of Medicare discharges over the 2010–15 period, we evaluate the impact of this program. We select as a comparison group hospitals in the Chicago area with similar pretreatment trends in readmission rates and total discharges. Treatment-on-treated estimates indicate that the CSCTC program reduced 30-, 60-, and 90-day readmission rates by a statistically significant 14 percent or more of the sample mean, and reduced readmission costs an amount equal to CSCTC program cost. Effects are driven by black and Hispanic patients as well as those with dual eligibility for both Medicare and Medicaid.