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.
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).
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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