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Medicare Patients with Heart Failure, Attack, Pneumonia Return to Hospital for New Reasons

Diagnoses associated with 30-day re-admission are diverse and not associated with patient demographics or time after discharge for older patients

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Jan. 23, 2013 – Among approximately 3 million Medicare patients hospitalized for heart failure, heart attack, or pneumonia, re-admissions were frequent throughout the 30 days following the hospitalization, and resulted from a wide variety of diagnoses that often differed from the cause of the index hospitalization, according to a study appearing in the January 23/30 issue of the Journal of the American Medical Association (JAMA).

“Hospital re-admissions are common and can be a marker of poor health care quality and efficiency. To lower readmission rates, the Centers for Medicare & Medicaid Services (CMS) began publicly reporting 30-day risk-standardized readmission rates for heart failure (HF), acute myocardial infarction [MI; heart attack], and pneumonia after these measures were endorsed by the National Quality Forum.

These measures are part of a federal strategy to provide incentives to improve quality of care by reducing preventable re-admissions. Critical to the development of effective programs to reduce readmission is an understanding of the diagnoses and timing associated with these events,” according to background information in the article. “Insights into the diversity and variation of readmission diagnoses can illustrate the potential benefits of general vs. disease-specific interventions in reducing the overall number of re-admissions.”


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Medicare Efforts to Slow Hospital Re-Admissions, Hospitalizations Makes Some Gains in Tough Fight

Re-hospitalizations, hospitalizations down but rate of re-admissions to discharges holds steady

Jan. 23, 2013


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Kumar SeeDharmarajan, M.D., M.B.A., of Columbia University Medical Center, New York, and colleagues analyzed 2007-2009 Medicare fee-for-service claims data to examine readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after hospitalization for HF, heart attack, or pneumonia, conditions that are primarily responsible for almost 15 percent of hospitalizations in older persons, and are the focus of current public reporting efforts.

During the time period analyzed, the researchers identified -
 > 329,308 30-day re-admissions after 1,330,157 hospitalizations for HF (24.8 percent readmitted),
 > 108,992 30-day re-admissions after 548,834 hospitalizations for acute MI (19.9 percent readmitted), and
 > 214,239 30-day re-admissions after 1,168,624 hospitalizations for pneumonia (18.3 percent readmitted).

Following hospitalization for HF and acute MI, readmission was most often due to HF (35.2 percent and 19.3 percent of re-admissions, respectively). Following hospitalizations for pneumonia, readmission was most likely for recurrent pneumonia (22.4 percent).

“Of all 30-day re-admissions, we found that 61.0 percent of the HF, 67.6 percent of the acute MI, and 62.6 percent of the pneumonia cohorts occurred during days 0 through 15 following discharge. More than 30 percent of 30-day re-admissions occurred during days 16 through 30 for all 3 cohorts,” the authors write.

Median (midpoint) times to readmission were 12 days for patients initially hospitalized with HF, 10 days for patients initially hospitalized with acute MI, and 12 days for patients initially hospitalized with pneumonia. Neither readmission diagnoses nor timing substantively varied by age, sex, or race.

“The diagnoses associated with 30-day re-admission are diverse and are not associated with patient demographic characteristics or time after discharge for older patients initially hospitalized with HF, acute MI, or pneumonia. Although a high percentage of 30-day re-admissions occurred relatively soon after hospitalization, re-admissions remained frequent during days 16 through 30 after discharge regardless of patient age, sex, or race.

"This heightened vulnerability of recently hospitalized patients to a broad spectrum of conditions throughout the post-discharge period favors a generalized approach to preventing re-admissions that is broadly applicable across potential readmission diagnoses and effective for at least the full month after hospitalization. Strategies that are specific to particular diseases or periods may only address a fraction of patients at risk for re-hospitalization,” the authors write.


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