Association of US centers for medicare and medicaid services hospital 30-day risk-standardized readmission metric with care quality and outcomes after acute myocardial infarction

Ambarish Pandey, Harsh Golwala, Hurst M. Hall, Tracy Y. Wang, Di Lu, Ying Xian, Karen Chiswell, Karen E. Joynt, Abhinav Goyal, Sandeep R. Das, Dharam Kumbhani, Howard Julien, Gregg C. Fonarow, James A. De Lemos

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Abstract

IMPORTANCE The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penalizes hospitals with higher-than-expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR] > 1) after acutemyocardial infarction (MI). However, the association of ERR with MI care processes and outcomes are notwell established. OBJECTIVE To evaluate the association between ERR forMI with in-hospital process of care measures and 1-year clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS Observational analysis of hospitalized patients with MI from National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines centers subject to the first cycle of the Hospital Readmissions Reduction Program between July 1, 2008, and June 30, 2011. EXPOSURES The ERR forMI (MI-ERR) in 2011. MAIN OUTCOMES AND MEASURES Adherence to process of care measures during index hospitalization in the overall study population and risk of the composite outcome of mortality or all-cause readmission within 1 year of discharge and its individual components among participants with available Centers for Medicare and Medicaid Services-linked data. RESULTS The median ages of patients in the MI-ERR greater than 1 and tertiles 1, 2, and 3 of the MI-ERR greater than 1 groupswere 64, 63, 64, and 63 years, respectively. Among 380 hospitals that treated a total of 176 644 patients with MI during the study period, 43%had MI-ERR greater than 1. The proportions of patients of black race, those with heart failure signs at admission, and bleeding complications increased with higher MI-ERR. Therewas no significant association between adherence to MI performance measures and MI-ERR (adjusted odds ratio, 0.94; 95%CI, 0.81-1.08, per 0.1-unit increase in MI-ERR for overall defect-free care). Among the 51 453 patients with 1-year outcomes data available, higher MI-ERRwas associated with higher adjusted risk of the composite outcome and all-cause readmission within 1 year of discharge. This associationwas largely driven by readmissions early after discharge andwas not significant in landmark analyses beginning 30 days after discharge. The MI-ERRwas not associated with risk for mortality within 1 year of discharge in the overall and 30-day landmark analyses. CONCLUSIONS AND RELEVANCE During the first cycle of the Hospital Readmissions Reduction Program, participating hospitals' risk-adjusted 30-day readmission rates followingMI were not associated with in-hospital quality ofMI care or clinical outcomes occurring after the first 30 days after discharge.

Original languageEnglish
Pages (from-to)723-731
Number of pages9
JournalJAMA Cardiology
Volume2
Issue number7
DOIs
StatePublished - Jul 2017
Externally publishedYes

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    Pandey, A., Golwala, H., Hall, H. M., Wang, T. Y., Lu, D., Xian, Y., Chiswell, K., Joynt, K. E., Goyal, A., Das, S. R., Kumbhani, D., Julien, H., Fonarow, G. C., & De Lemos, J. A. (2017). Association of US centers for medicare and medicaid services hospital 30-day risk-standardized readmission metric with care quality and outcomes after acute myocardial infarction. JAMA Cardiology, 2(7), 723-731. https://doi.org/10.1001/jamacardio.2017.1143