Trends in Hospital Readmissions and Mortality Rates

Jul 10, 2019
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Authors:
Khera R, Wang Y, Nasir K, et al.
Citation:
Evaluation of 30-Day Hospital Readmission and Mortality Rates Using Regression-Discontinuity Framework. J Am Coll Cardiol 2019;74:219-234.
Summary By:
Elizabeth A. Jackson, MD, FACC

Study Questions:

Are 30-day readmission reductions associated with deferring hospitalizations beyond the 30-day period?

Methods:

Among US hospitals in the Hospital Readmissions Reduction Program (HRRP), the authors calculated daily readmission rates for elderly Medicare fee-for-service beneficiaries through day 60 post-discharge following a hospitalization for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. The time period examined was from July 2008 to June 2016. The primary outcomes were hospital readmissions and mortality.

Results:

Of the 3,256 eligible hospitals,1,206 (37.1%) were teaching hospitals, 646 (19.8%) were for-profit, 2,777 (85.3%) were in urban areas, 705 (21.6%) were classified as safety net hospitals, and 2,768 (85.0%) had small/medium bed size (<500 beds). The median readmission rates for AMI in days 1-30 were 19.6% (interquartile range [IQR], 16.7-22.9%) and for days 31-60, post-discharge readmission rates were 7.8% (IQR, 6.5-9.4%). For HF, readmission rates were 23.0% (IQR, 20.6%-25.3%) and 11.4% (IQR, 10.2-12.6%) for days 1-30 and for days 31-60, respectively. For pneumonia, readmission rates were 17.5% (IQR, 15.4-19.8%) and 8.3% (IQR, 7.3-9.3%) for days 1-30 and for days 31-60, respectively. Daily readmission rates decreased across most of the 60 post-discharge days, with no discontinuities in the local polynomial regression for readmission at the 30-day mark, with a >95% power to detect 0.1% difference for each outcome across post-discharge day 30. There was no discontinuity in mortality at 30 days post-discharge, or for either outcome at hospitals that incurred readmission penalties.

Conclusions:

The investigators concluded that current evidence does not show that clinicians’ adopted strategies, specifically deferring admissions, had an affect on mortality in the 30-day period after discharge.

Perspective:

HRRP’s goal is to improve quality of care as patients are discharged. These data suggest that readmissions deferred to after 30 days are not widespread. Continued evaluation of trends in readmissions will help programs such as HRRP to improve care.

Keywords: Acute Coronary Syndrome, Heart Failure, Hospitalization, Hospitals, Teaching, Medicare, Myocardial Infarction, Outcome Assessment, Health Care, Patient Discharge, Patient Readmission, Pneumonia, Primary Prevention, Quality of Health Care


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