on November 10, 2009
Published online before print November 10, 2009, doi: 10.1161/CIRCHEARTFAILURE.109.885210
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Original Article |
Recent National Trends in Readmission Rates after Heart Failure Hospitalization
1 Mount Sinai School of Med., New York; James J. Peters Veterans Admin.Med. Center, Bronx, NY;
2 Yale University School of Medicine; Yale-New Haven Hospital, New Haven, CT;
3 Yale-New Haven Hospital, New Haven, CT;
4 Hospital General Universitario;
5 Yale University School of Medicine, New Haven, CT;
6 Harvard School of Public Health, Boston, MA;
7 University of Missouri at Kansas City; Mid America Heart Institute, Kansas City, MO
* Corresponding author; email: joseph.ross{at}mssm.edu
Background—In July 2009, Medicare will begin publicly reporting hospitals' risk-standardized, all-cause 30-day readmission rates (RSRRs) among fee-for-service beneficiaries discharged after heart failure hospitalization from all U.S. acute care non-federal hospitals. No recent national trends in RSRRs have been reported and it is not known if hospital-specific performance is improving or if variation in performance is decreasing.
Methods and Results—We used 2004-2006 Medicare administrative data to identify all fee-for-service beneficiaries admitted to a U.S. acute care hospital for heart failure and discharged alive. We estimated mean annual RSRRs, a National Quality Forum-endorsed metric for quality, using two-level hierarchical models that accounted for age, sex, and multiple co-morbidities; variation in quality was estimated by the standard deviation of the RSRRs. There were 570,996 distinct hospitalizations for heart failure in which the patient was discharged alive in 4728 hospitals in 2004; 544,550 in 4694 hospitals in 2005; and 501,234 in 4674 hospitals in 2006. Unadjusted 30-day all-cause readmission rates were virtually identical over this period: 23.0% in 2004, 23.3% in 2005, and 22.9% in 2006. The mean and standard deviation (SD) of RSRRs were also similar: mean [SD] of 23.7% [1.3] in 2004, 23.9% [1.4] in 2005, and 23.8% [1.4] in 2006, suggesting similar hospital variation throughout the study period.
Conclusions—National mean and RSRR distributions among Medicare beneficiaries discharged after heart failure hospitalization have not changed in recent years, indicating that there was neither improvement in hospital readmission rates nor in hospital variations in rates over this time period.
Key Words: epidemiology • heart failure • Centers for Medicare and Medicaid Services (US) • health policy • hospitalizations/rehospitalizations