Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia.

Krumholz HM, Lin Z, Keenan PS, Chen J, Ross JS, Drye EE, Bernheim SM, Wang Y, Bradley EH, Han LF, Normand SL.

Source

Department of Internal Medicine/Section of Cardiovascular Medicine, Yale University School of Medicine, 1 Church St, Ste 200, New Haven, CT 06510, USA. harlan.krumholz@yale.edu

Abstract

IMPORTANCE:

The Centers for Medicare & Medicaid Services publicly reports hospital 30-day, all-cause, risk-standardized mortality rates (RSMRs) and 30-day, all-cause, risk-standardized readmission rates (RSRRs) for acute myocardial infarction, heart failure, and pneumonia. The evaluation of hospital performance as measured by RSMRs and RSRRs has not been well characterized.

OBJECTIVE:

To determine the relationship between hospital RSMRs and RSRRs overall and within subgroups defined by hospital characteristics.

DESIGN, SETTING, AND PARTICIPANTS:

We studied Medicare fee-for-service beneficiaries discharged with acute myocardial infarction, heart failure, or pneumonia between July 1, 2005, and June 30, 2008 (4506 hospitals for acute myocardial infarction, 4767 hospitals for heart failure, and 4811 hospitals for pneumonia). We quantified the correlation between hospital RSMRs and RSRRs using weighted linear correlation; evaluated correlations in groups defined by hospital characteristics; and determined the proportion of hospitals with better and worse performance on both measures.

MAIN OUTCOME MEASURES:

Hospital 30-day RSMRs and RSRRs.

RESULTS:

Mean RSMRs and RSRRs, respectively, were 16.60% and 19.94% for acute myocardial infarction, 11.17% and 24.56% for heart failure, and 11.64% and 18.22% for pneumonia. The correlations between RSMRs and RSRRs were 0.03 (95% CI, -0.002 to 0.06) for acute myocardial infarction, -0.17 (95% CI, -0.20 to -0.14) for heart failure, and 0.002 (95% CI, -0.03 to 0.03) for pneumonia. The results were similar for subgroups defined by hospital characteristics. Although there was a significant negative linear relationship between RSMRs and RSRRs for heart failure, the shared variance between them was only 2.9% (r2 = 0.029), with the correlation most prominent for hospitals with RSMR <11 a="" acute="" admitted="" an="" and="" associated="" certain="" conclusion="" failure.="" for="" heart="" infarction="" mortality="" myocardial="" not="" only="" or="" p="" patients="" pneumonia="" range="" rates="" readmission="" relevance:="" risk-standardized="" weakly="" were="" with="" within="">