AHRQ Study Calculates Adverse Events Among Heart Attack Patients Treated at Hospitals With Poor Safety Performance

Hospitals with poor patient safety performance tended to have higher all-cause mortality and unplanned readmission rates for Medicare patients who were discharged following a heart attack, an AHRQ-funded study found. Researchers used 2009–2013 patient safety data from AHRQ’s Medicare Patient Safety Monitoring System, along with Centers for Medicare & Medicaid Services hospital mortality and readmission data, to conduct an analysis of heart attack patients in 793 acute-care hospitals. Hospitals’ patient safety ratings are based on 21 in-hospital adverse event measures. Researchers found that a 1 percent increase in adverse events was associated with average 4.9 percent increase in mortality and a 3.4 percent increase in unplanned readmission rates. The study, “Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients With Acute Myocardial Infarction,” and abstractappeared in the July issue of the Journal of the American Heart Association.

Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients Wit... - PubMed - NCBI

2016 Jul 12;5(7). pii: e003731. doi: 10.1161/JAHA.116.003731.

Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients With Acute Myocardial Infarction.

Wang Y1, Eldridge N2, Metersky ML3, Sonnenfeld N4, Fine JM5, Pandolfi MM6, Eckenrode S6, Bakullari A6, Galusha DH7, Jaser L8, Verzier NR6, Nuti SV9,Hunt D10, Normand SL11, Krumholz HM12.

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Abstract

BACKGROUND:

Little is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30-day mortality and unplanned readmission rates for Medicare fee-for-service patients hospitalized for acute myocardial infarction (AMI).

METHODS AND RESULTS:

Using 2009-2013 medical record-abstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixed-effects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospital-specific risk-standardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospital-specific 30-day all-cause risk-standardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the risk-standardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79-8.94) and 3.44% points (95% CI, 0.19-6.68) for the risk-standardized mortality and unplanned readmission rates, respectively.

CONCLUSIONS:

For Medicare fee-for-service patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30-day all-cause mortality and on unplanned readmissions.