Association of 30-Day Readmission Metric for Heart Failure Under the Hospital Readmissions Reduction Program With Quality of Care and Outcomes

Ambarish Pandey, Harsh Golwala, Haolin Xu, Adam D. DeVore, Roland Matsouaka, Michael Pencina, Dharam J. Kumbhani, Adrian F. Hernandez, Deepak L. Bhatt, Paul A. Heidenreich, Clyde W. Yancy, James A. de Lemos, Gregg C. Fonarow

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objectives This study sought to determine whether processes of care and long-term clinical outcomes for heart failure (HF) admissions across Get With The Guidelines-Heart Failure (GWTG-HF) program participating centers differ according to HF-specific risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]) as determined by the Hospital Readmission Reduction Program (HRRP). Background HRRP penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (ERR >1) for common conditions including HF. However, it is unclear whether the differences in this metric of hospital performance used by HRRP and related penalties are associated with measured quality of care and long-term outcomes. Methods We analyzed data from the GWTG-HF registry linked to Medicare claims from July 2008 to June 2011. Using publically available data on HF-ERR in 2013, we stratified the participating centers into groups with low (HF-ERR ≤1) versus high (HF-ERR >1) risk-adjusted readmission rates. We compared the care quality, in-hospital, and 1-year clinical outcomes across the 2 groups in unadjusted and multivariable adjusted analysis. Results The analysis included 171 centers with 43,143 participants; 49% of centers had high risk-adjusted 30-day readmission rates (HF-ERR >1). There were no differences between the low and high risk-adjusted 30-day readmission groups in median adherence rate to all performance measures (95.7% vs. 96.5%; p = 0.37) or median percentage of defect-free care (90.0% vs. 91.1%; p = 0.47). The composite 1-year outcome of death or all-cause readmission rates was also not different between the 2 groups (median 62.9% vs. 65.3%; p = 0.10). The high HF-ERR group had higher 1-year all-cause readmission rates (median 59.1% vs. 54.7%; p = 0.01). However, the 1-year mortality rates were lower among high versus low HF-ERR group with a trend toward statistical significance (median 28.2% vs. 31.7%; p = 0.07). Conclusions Quality of care and clinical outcomes were comparable among hospitals with high versus low risk-adjusted 30-day HF readmission rates. These findings raise questions about the validity of the HRRP performance metric in identifying and penalizing low-performance centers.

Original languageEnglish (US)
Pages (from-to)935-946
Number of pages12
JournalJACC: Heart Failure
Volume4
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Fingerprint

Quality of Health Care
Heart Failure
Patient Readmission
Guidelines
Long-Term Care
Medicare
Registries

Keywords

  • heart failure
  • mortality
  • quality of care
  • readmission

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of 30-Day Readmission Metric for Heart Failure Under the Hospital Readmissions Reduction Program With Quality of Care and Outcomes. / Pandey, Ambarish; Golwala, Harsh; Xu, Haolin; DeVore, Adam D.; Matsouaka, Roland; Pencina, Michael; Kumbhani, Dharam J.; Hernandez, Adrian F.; Bhatt, Deepak L.; Heidenreich, Paul A.; Yancy, Clyde W.; de Lemos, James A.; Fonarow, Gregg C.

In: JACC: Heart Failure, Vol. 4, No. 12, 01.12.2016, p. 935-946.

Research output: Contribution to journalArticle

Pandey, A, Golwala, H, Xu, H, DeVore, AD, Matsouaka, R, Pencina, M, Kumbhani, DJ, Hernandez, AF, Bhatt, DL, Heidenreich, PA, Yancy, CW, de Lemos, JA & Fonarow, GC 2016, 'Association of 30-Day Readmission Metric for Heart Failure Under the Hospital Readmissions Reduction Program With Quality of Care and Outcomes', JACC: Heart Failure, vol. 4, no. 12, pp. 935-946. https://doi.org/10.1016/j.jchf.2016.07.003
Pandey, Ambarish ; Golwala, Harsh ; Xu, Haolin ; DeVore, Adam D. ; Matsouaka, Roland ; Pencina, Michael ; Kumbhani, Dharam J. ; Hernandez, Adrian F. ; Bhatt, Deepak L. ; Heidenreich, Paul A. ; Yancy, Clyde W. ; de Lemos, James A. ; Fonarow, Gregg C. / Association of 30-Day Readmission Metric for Heart Failure Under the Hospital Readmissions Reduction Program With Quality of Care and Outcomes. In: JACC: Heart Failure. 2016 ; Vol. 4, No. 12. pp. 935-946.
@article{8b57133b265c4c4f8478eeaa08c571dd,
title = "Association of 30-Day Readmission Metric for Heart Failure Under the Hospital Readmissions Reduction Program With Quality of Care and Outcomes",
abstract = "Objectives This study sought to determine whether processes of care and long-term clinical outcomes for heart failure (HF) admissions across Get With The Guidelines-Heart Failure (GWTG-HF) program participating centers differ according to HF-specific risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]) as determined by the Hospital Readmission Reduction Program (HRRP). Background HRRP penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (ERR >1) for common conditions including HF. However, it is unclear whether the differences in this metric of hospital performance used by HRRP and related penalties are associated with measured quality of care and long-term outcomes. Methods We analyzed data from the GWTG-HF registry linked to Medicare claims from July 2008 to June 2011. Using publically available data on HF-ERR in 2013, we stratified the participating centers into groups with low (HF-ERR ≤1) versus high (HF-ERR >1) risk-adjusted readmission rates. We compared the care quality, in-hospital, and 1-year clinical outcomes across the 2 groups in unadjusted and multivariable adjusted analysis. Results The analysis included 171 centers with 43,143 participants; 49{\%} of centers had high risk-adjusted 30-day readmission rates (HF-ERR >1). There were no differences between the low and high risk-adjusted 30-day readmission groups in median adherence rate to all performance measures (95.7{\%} vs. 96.5{\%}; p = 0.37) or median percentage of defect-free care (90.0{\%} vs. 91.1{\%}; p = 0.47). The composite 1-year outcome of death or all-cause readmission rates was also not different between the 2 groups (median 62.9{\%} vs. 65.3{\%}; p = 0.10). The high HF-ERR group had higher 1-year all-cause readmission rates (median 59.1{\%} vs. 54.7{\%}; p = 0.01). However, the 1-year mortality rates were lower among high versus low HF-ERR group with a trend toward statistical significance (median 28.2{\%} vs. 31.7{\%}; p = 0.07). Conclusions Quality of care and clinical outcomes were comparable among hospitals with high versus low risk-adjusted 30-day HF readmission rates. These findings raise questions about the validity of the HRRP performance metric in identifying and penalizing low-performance centers.",
keywords = "heart failure, mortality, quality of care, readmission",
author = "Ambarish Pandey and Harsh Golwala and Haolin Xu and DeVore, {Adam D.} and Roland Matsouaka and Michael Pencina and Kumbhani, {Dharam J.} and Hernandez, {Adrian F.} and Bhatt, {Deepak L.} and Heidenreich, {Paul A.} and Yancy, {Clyde W.} and {de Lemos}, {James A.} and Fonarow, {Gregg C.}",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.jchf.2016.07.003",
language = "English (US)",
volume = "4",
pages = "935--946",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",
number = "12",

}

TY - JOUR

T1 - Association of 30-Day Readmission Metric for Heart Failure Under the Hospital Readmissions Reduction Program With Quality of Care and Outcomes

AU - Pandey, Ambarish

AU - Golwala, Harsh

AU - Xu, Haolin

AU - DeVore, Adam D.

AU - Matsouaka, Roland

AU - Pencina, Michael

AU - Kumbhani, Dharam J.

AU - Hernandez, Adrian F.

AU - Bhatt, Deepak L.

AU - Heidenreich, Paul A.

AU - Yancy, Clyde W.

AU - de Lemos, James A.

AU - Fonarow, Gregg C.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Objectives This study sought to determine whether processes of care and long-term clinical outcomes for heart failure (HF) admissions across Get With The Guidelines-Heart Failure (GWTG-HF) program participating centers differ according to HF-specific risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]) as determined by the Hospital Readmission Reduction Program (HRRP). Background HRRP penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (ERR >1) for common conditions including HF. However, it is unclear whether the differences in this metric of hospital performance used by HRRP and related penalties are associated with measured quality of care and long-term outcomes. Methods We analyzed data from the GWTG-HF registry linked to Medicare claims from July 2008 to June 2011. Using publically available data on HF-ERR in 2013, we stratified the participating centers into groups with low (HF-ERR ≤1) versus high (HF-ERR >1) risk-adjusted readmission rates. We compared the care quality, in-hospital, and 1-year clinical outcomes across the 2 groups in unadjusted and multivariable adjusted analysis. Results The analysis included 171 centers with 43,143 participants; 49% of centers had high risk-adjusted 30-day readmission rates (HF-ERR >1). There were no differences between the low and high risk-adjusted 30-day readmission groups in median adherence rate to all performance measures (95.7% vs. 96.5%; p = 0.37) or median percentage of defect-free care (90.0% vs. 91.1%; p = 0.47). The composite 1-year outcome of death or all-cause readmission rates was also not different between the 2 groups (median 62.9% vs. 65.3%; p = 0.10). The high HF-ERR group had higher 1-year all-cause readmission rates (median 59.1% vs. 54.7%; p = 0.01). However, the 1-year mortality rates were lower among high versus low HF-ERR group with a trend toward statistical significance (median 28.2% vs. 31.7%; p = 0.07). Conclusions Quality of care and clinical outcomes were comparable among hospitals with high versus low risk-adjusted 30-day HF readmission rates. These findings raise questions about the validity of the HRRP performance metric in identifying and penalizing low-performance centers.

AB - Objectives This study sought to determine whether processes of care and long-term clinical outcomes for heart failure (HF) admissions across Get With The Guidelines-Heart Failure (GWTG-HF) program participating centers differ according to HF-specific risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]) as determined by the Hospital Readmission Reduction Program (HRRP). Background HRRP penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (ERR >1) for common conditions including HF. However, it is unclear whether the differences in this metric of hospital performance used by HRRP and related penalties are associated with measured quality of care and long-term outcomes. Methods We analyzed data from the GWTG-HF registry linked to Medicare claims from July 2008 to June 2011. Using publically available data on HF-ERR in 2013, we stratified the participating centers into groups with low (HF-ERR ≤1) versus high (HF-ERR >1) risk-adjusted readmission rates. We compared the care quality, in-hospital, and 1-year clinical outcomes across the 2 groups in unadjusted and multivariable adjusted analysis. Results The analysis included 171 centers with 43,143 participants; 49% of centers had high risk-adjusted 30-day readmission rates (HF-ERR >1). There were no differences between the low and high risk-adjusted 30-day readmission groups in median adherence rate to all performance measures (95.7% vs. 96.5%; p = 0.37) or median percentage of defect-free care (90.0% vs. 91.1%; p = 0.47). The composite 1-year outcome of death or all-cause readmission rates was also not different between the 2 groups (median 62.9% vs. 65.3%; p = 0.10). The high HF-ERR group had higher 1-year all-cause readmission rates (median 59.1% vs. 54.7%; p = 0.01). However, the 1-year mortality rates were lower among high versus low HF-ERR group with a trend toward statistical significance (median 28.2% vs. 31.7%; p = 0.07). Conclusions Quality of care and clinical outcomes were comparable among hospitals with high versus low risk-adjusted 30-day HF readmission rates. These findings raise questions about the validity of the HRRP performance metric in identifying and penalizing low-performance centers.

KW - heart failure

KW - mortality

KW - quality of care

KW - readmission

UR - http://www.scopus.com/inward/record.url?scp=84999188071&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84999188071&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2016.07.003

DO - 10.1016/j.jchf.2016.07.003

M3 - Article

C2 - 27908393

AN - SCOPUS:84999188071

VL - 4

SP - 935

EP - 946

JO - JACC: Heart Failure

JF - JACC: Heart Failure

SN - 2213-1779

IS - 12

ER -