Complications of hospital care are a significant problem with up to 20% of all acute hospital admissions involving a complication of care within the admission. In addition, many complications of care present as readmissions. Readmissions occur frequently with 15-20% of patients being readmitted within one month of an acute inpatient admission.
Hospital funding policies compensate for the patient care based activities undertaken rather than the quality of the care provided. US Medicare has developed the first policy to refuse payment for substandard care, the (non-payment for) Hospital Acquired Conditions policy.
This dissertation has two converging foci: non-payment for complications of, and readmissions following, acute hospital care. There are few existing theoretical frameworks that address these converging foci. A model, based on work by Stone et al, provides a theoretical framework for supporting, and further defining the use of, funding policies to drive reductions in complications of care.
Five published studies are presented. Each study uses administrative data to develop, interrogate, and / or suggest improvements to, funding models that include incentives for improving patient outcomes. The first study outlines a novel approach involving the funding of hospital admissions at a complication-averaged rate. The second study reports the financial impact for hospitals of non-payment for a suite of preventable complications of care defined by US Medicare as HACs. The second study is replicated as study three where the financial impact of the introduction of this policy in Victoria, Australia is estimated. The fourth study defines the incidence and associated costs of readmissions that are a direct consequence of medical or surgical care. The fifth study looks at the impact of including readmissions in US Medicare’s non-payment for HAC Policy.
Responses to the publications, the degree to which these papers were able to meet the objectives of the theoretical framework and a refined theoretical framework developed throughout the dissertation are discussed in the final chapter.
Each of the five funding policy studies uses administrative data to assess and or (further) develop funding incentives designed to drive reductions in complications of clinical care in hospitals.
While none of the policy recommendations included in this dissertation have been implemented to date, two studies (those published first) have been referenced by other publications. It will be interesting, as both observer and participant in this area of research, to plot the impact (if any) of the studies comprising this dissertation moving forward.