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A Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get With The Guidelines-Heart Failure.

Publication ,  Journal Article
Jalnapurkar, S; Zhao, X; Heidenreich, PA; Bhatt, DL; Smith, EE; DeVore, AD; Hernandez, AF; Matsouaka, R; Yancy, CW; Fonarow, GC
Published in: Am Heart J
June 2018

BACKGROUND: Medicare utilizes 30-day risk-standardized readmission rates (RSRR) as a measure of hospital quality and applies penalties based on this measure. The objective of this study was to identify the relationship between hospital performance on 30-day RSRR in heart failure (HF) patients and long-term patient survival. METHODS: Data were collected from Get With The Guidelines (GWTG)-HF and linked with Medicare data. Based on hospital performance for 30-day RSRR, hospitals were grouped into performance quartiles: top 25% (N=11,181), 25-50% (N=10,367), 50-75% (N=8729), and bottom 25% (N=7180). The primary outcome was mortality at 3 years applying Cox proportional hazards regression adjusted for patient and hospital characteristics. RESULTS: The overall 30-day readmission rate was 19.8% and the 3-year mortality rates were 61.8%, 61.0%, 62.6%, and 59.9% for top 25%, 25-50%, 50-75%, and bottom 25% hospitals for 30-day RSRR performance, respectively. Compared to bottom 25% performing hospitals, adjusted hazard ratios (HR) for 3-year mortality were HR 0.96 (95% confidence interval [CI] 0.90-1.01), HR 0.89 (95% CI 0.84-0.94), HR 1.01 (95% CI 0.95-1.06) for the top 25%, 25-50% and 50-75% hospitals respectively. Median survival time was highest for the bottom 25% hospitals on the 30-day RSRR metric. CONCLUSION: Hospital performance on 30-day readmissions in HF has no or little association with risk adjusted 3-year mortality or median survival. There is a compelling need to utilize more meaningful and patient-centered outcome measures for reporting and incentivizing quality care for HF.

Duke Scholars

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2018

Volume

200

Start / End Page

127 / 133

Location

United States

Related Subject Headings

  • United States
  • Survival Analysis
  • Quality of Health Care
  • Patient Readmission
  • Outcome Assessment, Health Care
  • Needs Assessment
  • Medicare
  • Male
  • Humans
  • Hospitals
 

Citation

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MLA
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Jalnapurkar, S., Zhao, X., Heidenreich, P. A., Bhatt, D. L., Smith, E. E., DeVore, A. D., … Fonarow, G. C. (2018). A Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get With The Guidelines-Heart Failure. Am Heart J, 200, 127–133. https://doi.org/10.1016/j.ahj.2017.11.018
Jalnapurkar, Sawan, Xin Zhao, Paul A. Heidenreich, Deepak L. Bhatt, Eric E. Smith, Adam D. DeVore, Adrian F. Hernandez, Roland Matsouaka, Clyde W. Yancy, and Gregg C. Fonarow. “A Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get With The Guidelines-Heart Failure.Am Heart J 200 (June 2018): 127–33. https://doi.org/10.1016/j.ahj.2017.11.018.
Jalnapurkar S, Zhao X, Heidenreich PA, Bhatt DL, Smith EE, DeVore AD, et al. A Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get With The Guidelines-Heart Failure. Am Heart J. 2018 Jun;200:127–33.
Jalnapurkar, Sawan, et al. “A Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get With The Guidelines-Heart Failure.Am Heart J, vol. 200, June 2018, pp. 127–33. Pubmed, doi:10.1016/j.ahj.2017.11.018.
Jalnapurkar S, Zhao X, Heidenreich PA, Bhatt DL, Smith EE, DeVore AD, Hernandez AF, Matsouaka R, Yancy CW, Fonarow GC. A Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get With The Guidelines-Heart Failure. Am Heart J. 2018 Jun;200:127–133.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2018

Volume

200

Start / End Page

127 / 133

Location

United States

Related Subject Headings

  • United States
  • Survival Analysis
  • Quality of Health Care
  • Patient Readmission
  • Outcome Assessment, Health Care
  • Needs Assessment
  • Medicare
  • Male
  • Humans
  • Hospitals