Research Activities, February 2014
30-day rehospitalization is a poor indicator of outcomes and resource use in patients with heart failure
Patient Safety and Quality of Care
Among Medicare beneficiaries, heart failure is the most common reason for hospitalization. The associated costs exceed more than $38 billion each year. More than a quarter of patients in the hospital for heart failure will be readmitted within 30 days of their discharge. Medicare and Medicaid are looking for ways to prevent these rehospitalizations. Hospitals may feel pressured to discharge patients early to maximize revenue. A new study concludes that the total inpatient days over an episode of care (EOC) is the best indicator of resource use for hospitalized patients with heart failure and rehospitalization within 30 days is a poor indicator of resource use.
Researchers used data from the American Heart Association's Get With the Guidelines®-Heart Failure quality improvement registry, which is linked to Medicare claims. They analyzed data on 17,387 patients with heart failure at 149 hospitals. Hospitals were ranked and compared by length of stay (LOS), 30-day readmission rate, and overall EOC metric defined as all hospital days for a heart failure admission and any subsequent admissions within 30 days.
The median 30-day readmission rate was 23.2 percent and the median LOS was 4.9 days. The overall EOC was 6.2 days. According to the findings, the hospital heart failure readmission rate was not associated with initial hospital LOS. No association was found between 30-day readmission and decreased 30-day mortality. The better performing metric was the EOC. A shorter length of stay was associated with decreased odds of 30-day mortality. Interestingly, hospitals with the shortest rates of 30-day readmission performed worse on heart failure performance measures.
According to the researchers, total hospital days over a 30-day EOC may be a more accurate measure of outcomes and resource use when it comes to heart failure care. The study was supported in part by AHRQ (HS16964).
See "Are we targeting the right metric for heart failure? Comparison of hospital 30-day readmission rates and total episode of care inpatient days," by Robb D. Kociol, M.D., Li Liang, Ph.D., Adrian F. Hernandez, M.D., M.H.S., and others in the June 2013 American Heart Journal 165, pp. 987-994.e1.