Dataset Information

Trends in Hospital Readmission of Medicare-Covered Patients With Heart Failure.

ABSTRACT: BACKGROUND:The Medicare Hospital Readmissions Reduction Program has led to fewer readmissions following hospitalizations with a principal diagnosis of heart failure (HF). Patients with HF are frequently hospitalized for other causes. OBJECTIVES:This study sought to compare trends in Medicare risk-adjusted, 30-day readmissions following principal HF hospitalizations and other hospitalizations with HF. METHODS:This was a retrospective study of 12,973,853 Medicare hospitalizations with a principal or secondary diagnosis of HF between January 2008 and June 2015. Hospitalizations were categorized as follows: principal HF hospitalizations; principal acute myocardial infarction or pneumonia hospitalizations with secondary HF; and other hospitalizations with secondary HF. The study examined trends in risk-adjusted, 30-day, all-cause readmission rates for each cohort and trends in differences in readmission rates among cohorts by using linear spline regression models. RESULTS:Before passage of the Affordable Care Act in March 2010, risk-adjusted, 30-day readmission rates were stable for all 3 cohorts, with mean monthly rates of 26.1%, 24.9%, and 24.4%, respectively. Risk-adjusted readmission rates started declining after passage of the Affordable Care Act by 1.09% (95% confidence interval [CI]: 0.51% to 1.68%), 1.24% (95% CI: 0.92% to 1.57%), and 1.05% (95% CI: 0.52% to 1.58%) per year, respectively, until implementation of the Hospital Readmissions Reduction Program in October 2012 and then stabilized for all 3 cohorts. CONCLUSIONS:Patients with HF are often hospitalized for other causes, and these hospitalizations have high readmission rates. Policy changes led to decreases in readmission rates for both principal and secondary HF hospitalizations. Readmission rates in both groups remain high, suggesting that initiatives targeting all hospitalized patients with HF continue to be warranted.

SUBMITTER: Blecker S

PROVIDER: S-EPMC7011858 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Trends in Hospital Readmission of Medicare-Covered Patients With Heart Failure.

Blecker Saul S Herrin Jeph J Li Li L Yu Huihui H Grady Jacqueline N JN Horwitz Leora I LI

Journal of the American College of Cardiology 20190301 9

<h4>Background</h4>The Medicare Hospital Readmissions Reduction Program has led to fewer readmissions following hospitalizations with a principal diagnosis of heart failure (HF). Patients with HF are frequently hospitalized for other causes.<h4>Objectives</h4>This study sought to compare trends in Medicare risk-adjusted, 30-day readmissions following principal HF hospitalizations and other hospitalizations with HF.<h4>Methods</h4>This was a retrospective study of 12,973,853 Medicare hospitalizat ...[more]

PMID: 30846093

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Project description:ImportanceDespite advances in treatment and care quality for patients hospitalized with heart failure (HF), minimal improvement in mortality has been observed after HF hospitalization since 2010.ObjectiveTo evaluate trends in mortality rates across specific intervals after hospitalization.Design, setting, and participantsThis cohort study evaluated a random sample of Medicare fee-for-service beneficiaries with incident HF hospitalization from January 1, 2008, to December 31, 2018. Data were analyzed from February 2023 to May 2024.Main outcomes and measuresUnadjusted mortality rates were calculated by dividing the number of all-cause deaths by the number of patients with incident HF hospitalization for the following periods: in-hospital, 30 days (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), intermediate term (1-2 years after discharge), and long term (2-3 years after discharge). Each period was considered separately (ie, patients who died during one period were not counted in subsequent periods). Annual unadjusted and risk-adjusted mortality ratios were calculated (using logistic regression to account for differences in patient characteristics), defined as observed mortality divided by expected mortality based on 2008 rates.ResultsA total of 1 256 041 patients (mean [SD] age, 83.0 [7.6] years; 56.0% female; 86.0% White) were hospitalized with incident HF. There was a substantial decrease in the mortality ratio for the in-hospital period (unadjusted ratio, 0.77; 95% CI, 0.67-0.77; risk-adjusted ratio, 0.74; 95% CI, 0.71-0.76). For subsequent periods, mortality ratios increased through 2013 and then decreased through 2018, resulting in no reductions in unadjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.94; 95% CI, 0.82-1.06; short-term mortality ratio, 1.02; 95% CI, 0.87-1.17; intermediate-term mortality ratio, 0.99; 95% CI, 0.79-1.19; and long-term mortality ratio, 0.96; 95% CI, 0.76-1.16) and small reductions in risk-adjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.88; 95% CI, 0.86-0.90; short-term mortality ratio, 0.94; 95% CI, 0.94-0.95; intermediate-term mortality ratio, 0.94; 95% CI, 0.92-0.95; and long-term mortality ratio, 0.95; 95% CI, 0.93-0.96).Conclusions and relevanceIn this study of Medicare fee-for-service beneficiaries, there was a substantial decrease in in-hospital mortality for patients hospitalized with incident HF from 2008 to 2018, but little to no reduction in mortality for subsequent periods up to 3 years after hospitalization. These results suggest opportunities to improve longitudinal outpatient care for patients with HF after hospital discharge.

Project description:BackgroundDespite recent reductions in national unplanned readmission rates, we have relatively little understanding of which hospital strategies are most associated with changes in risk-standardized readmission rates (RSRR).ObjectiveWe examined associations between the change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies over 12-18 months in a national sample of hospitals.DesignWe conducted a prospective study of hospitals using a Web-based survey at baseline (November 2010-May 2011, n = 599, 91.0% response rate) and 12-18 months later (November 2011-October 2012, n = 501, 83.6% response rate), with RSRR measured at the same time points. The final analytic sample included 478 hospitals.ParticipantsThe study included hospitals participating in the Hospital-to-Home (H2H) and State Action on Avoidable Rehospitalizations (STAAR) initiatives.Main measuresWe examined associations between change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies previously demonstrated to have increased between baseline and follow-up, using unadjusted and adjusted linear regression.Key resultsThe average number of strategies taken up from baseline to follow-up was 1.6 (SE = 0.06); approximately one-quarter (25.3%) of hospitals took up at least three new strategies. Hospitals that adopted the strategy of routinely discharging patients with a follow-up appointment already scheduled experienced significant reductions in RSRR (reduction of 0.63 percentage point, p value < 0.05). Hospitals that took up three or more strategies had significantly greater reductions in RSRR compared to hospitals that took up only zero to two strategies (reduction of 1.29 versus 0.57 percentage point, p value < 0.05). Among the 117 hospitals that took up three or more strategies, 93 unique combinations of strategies were used.ConclusionsAlthough most individual strategies were not associated with RSRR reduction, hospitals that took up any three or more strategies showed significantly greater reduction in RSRR compared to hospitals that took up fewer than three strategies.

Project description:ObjectivesTo determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions.DesignRetrospective cohort study.SettingMedicare beneficiaries in the United States.ParticipantsPatients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09.Main outcome measuresReadmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services' condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥ 95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers.ResultsFor readmissions in the 30 days after the index admission, there were 320,003 after 1,291,211 admissions for heart failure (4041 hospitals), 102,536 after 517,827 admissions for acute myocardial infarction (2378 hospitals), and 208,438 after 1,135,932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P<0.001). Findings were unchanged after adjustment for other hospital characteristics potentially associated with readmission patterns.ConclusionsHigh performing hospitals have proportionately fewer 30 day readmissions without differences in readmission diagnoses and timing, suggesting the possible benefit of strategies that lower risk of readmission globally rather than for specific diagnoses or time periods after hospital stay.

Dataset Information

Trends in Hospital Readmission of Medicare-Covered Patients With Heart Failure.

Publications

Trends in Hospital Readmission of Medicare-Covered Patients With Heart Failure.

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