Care Strategies for Reducing Hospital Readmissions Using Stochastic Programming

• Published in: Healthcare (Basel) 2021-07, Vol.9 (8), p.940
• Main Authors: Lahijanian, Behshad, Alvarado, Michelle
• Format: Article
• Language: English
• Subjects: care strategy; Chronic obstructive pulmonary disease; Costs; Decision making; Design; Estimates; Fines & penalties; hospital readmission; Hospitalization; Hospitals; Machine learning; Medicaid; Medicare; Optimization; OR in health services; Patients; probabilistic constraints; Probability; scenario-based stochastic programming; Survival analysis; Systematic review
• ISSN: 2227-9032; 2227-9032
• DOI: 10.3390/healthcare9080940

A hospital readmission occurs when a patient has an unplanned admission to a hospital within a specific time period of discharge from an earlier or initial hospital stay. Preventable readmissions have turned into a critical challenge for the healthcare system globally, and hospitals seek care strategies that reduce the readmission burden. Some countries have developed hospital readmission reduction policies, and in some cases, these policies impose financial penalties for hospitals with high readmission rates. Decision models are needed to help hospitals identify care strategies that avoid financial penalties, yet maintain balance among quality of care, the cost of care, and the hospital’s readmission reduction goals. We develop a multi-condition care strategy model to help hospitals prioritize treatment plans and allocate resources. The stochastic programming model has probabilistic constraints to control the expected readmission probability for a set of patients. The model determines which care strategies will be the most cost-effective and the extent to which resources should be allocated to those initiatives to reach the desired readmission reduction targets and maintain high quality of care. A sensitivity analysis was conducted to explore the value of the model for low- and high-performing hospitals and multiple health conditions. Model outputs are valuable to hospitals as they examine the expected cost of hitting its target and the expected improvement to its readmission rates.