Research Activities, June 2013
Certain medical conditions and Medicaid insurance predict hospital readmission for congestive heart failure
Patient Safety and Quality
Congestive heart failure (CHF) is the most common reason for hospital readmission among beneficiaries of fee-for-service Medicare plans. It is the third most common cause of rehospitalization among all patients regardless of their type of insurance coverage. A new study has identified several coexisting illnesses linked to hospital readmissions. It also found that Medicaid-insured patients had high readmission rates for CHF.
AHRQ researchers Roxanne M. Andrews, Ph.D., Ryan Mutter, Ph.D., Ernest Moy, M.D., M.P.H. and coinvestigators analyzed AHRQ’s Healthcare Cost and Utilization Project State Inpatient Databases for 14 States to identify patients who had a hospital admission for CHF during 2006. They also looked to see if they had a readmission within 30 days of hospital discharge. They conducted multivariate analyses to look at factors related to readmission, including patient, hospital, and community characteristics, and cost per hospital stay.
Medicaid-insured patients had nearly twice the readmission rate of privately insured patients and 50 percent higher readmission rates than those insured by Medicare. These differences remained, though were diminished, even after the researchers controlled for clinical and other patient factors, and hospital and community characteristics. Certain medical conditions such as drug abuse, psychoses, and renal failure also predicted a higher likelihood of being readmitted to the hospital for CHF. The odds of readmission for female patients were lower than male patients.
There was only a weak negative association between the cost of treatment for the first CHF admission and the likelihood of 30-day readmission. Given the increased risks for readmission among Medicaid patients and those with drug abuse problems, the researchers suggest more interventions to target these groups that involve better coordination of care for CHF.
More details are in "Congestive heart failure: Who is likely to be readmitted?" by Drs. Andrews, Mutter, and Moy, and others in the October 2012 Medical Care Research and Review 69(5), pp. 602-616. Reprints (AHRQ Publication No. 12-R094) are available from AHRQ.