Abstract
Background: Medicare utilizes 30-day risk-standardized readmission rates (RSRR) as a measure of hospital quality and applies penalties based on this measure. The objective of this study was to identify the relationship between hospital performance on 30-day RSRR in heart failure (HF) patients and long-term patient survival. Methods: Data were collected from Get With The Guidelines (GWTG)-HF and linked with Medicare data. Based on hospital performance for 30-day RSRR, hospitals were grouped into performance quartiles: top 25% (N=11,181), 25-50% (N=10,367), 50-75% (N=8729), and bottom 25% (N=7180). The primary outcome was mortality at 3 years applying Cox proportional hazards regression adjusted for patient and hospital characteristics. Results: The overall 30-day readmission rate was 19.8% and the 3-year mortality rates were 61.8%, 61.0%, 62.6%, and 59.9% for top 25%, 25-50%, 50-75%, and bottom 25% hospitals for 30-day RSRR performance, respectively. Compared to bottom 25% performing hospitals, adjusted hazard ratios (HR) for 3-year mortality were HR 0.96 (95% confidence interval [CI] 0.90-1.01), HR 0.89 (95% CI 0.84-0.94), HR 1.01 (95% CI 0.95-1.06) for the top 25%, 25-50% and 50-75% hospitals respectively. Median survival time was highest for the bottom 25% hospitals on the 30-day RSRR metric. Conclusion: Hospital performance on 30-day readmissions in HF has no or little association with risk adjusted 3-year mortality or median survival. There is a compelling need to utilize more meaningful and patient-centered outcome measures for reporting and incentivizing quality care for HF.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 127-133 |
| Number of pages | 7 |
| Journal | American heart journal |
| Volume | 200 |
| DOIs | |
| State | Published - Jun 2018 |
Funding
Author Disclosures: Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org ), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott); Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda. Dr. Adam D. DeVore reports research support from the American Heart Association, Amgen, and Novartis and consulting with Novartis. Dr Gregg Fonarow reports research support from NIH, consulting with Abbott, Amgen, Novartis, and Medtronic, and serving as a GWTG Steering Committee member. All other authors have nothing to disclose. The GWTG-HF database linked with CMS claims were the primary sources of the data. The design and objectives of the GWTG-HF registry have previously been described. 11-14 In brief, this registry includes more than 300 participating hospitals from each geographical region of the US. The registry includes teaching, non-teaching and community hospitals from both rural and urban areas, making it a comprehensive representation of the diversified US population of patients hospitalized with HF. Participating sites provide clinical information for each patient admitted with the primary diagnosis of HF or who developed HF during hospitalization through an internet-based patient management tool (Quintiles, Cambridge, MA). All participating hospitals are required to have institutional review board approval and individual patient informed consents were waived under the common rule. Post hospital discharge data are collected by linking registry hospitalization to Medicare Part A claims with the help of their dates of admission and discharge, sex and date of birth as previously described. 13 The claims files have data on Medicare enrollment and outcomes. Data are de-identified and electronically sent to the Duke Clinical Research Institute for analysis. This study was approved by the Duke Institutional Review Board. The American Heart Association provides GWTG-HF and funded this study. GWTG-HF is sponsored, in part, by Amgen Cardiovascular and has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents. Funding Sources: The American Heart Association provides the Get With The Guidelines Heart Failure program (GWTG-HF). GWTG-HF has been previously funded through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the AHA Pharmaceutical Roundtable.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine