Between 2009 and 2012, median 30-day risk-standardized unplanned readmission rates significantly declined for acute myocardial infarction (18.5% to 17.7%), heart failure (23.3% to 22.5%), and pneumonia (17.7% to 17.3%).
Cross-Sectional
Yes
Between 2009 and 2012, U.S. national unplanned 30-day readmission rates declined for AMI, HF, and pneumonia, while 30-day mortality declined for AMI, remained stable for pneumonia, and slightly increased for HF.
p-value: p=<0.001
BACKGROUND: The Centers for Medicare & Medicaid Services publicly reports risk-standardized mortality rates (RSMRs) within 30-days of admission and, in 2013, risk-standardized unplanned readmission rates (RSRRs) within 30-days of discharge for patients hospitalized with acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Current publicly reported data do not focus on variation in national results or annual changes. OBJECTIVE: Describe U.S. hospital performance on AMI, HF, and pneumonia mortality and updated readmission measures to provide perspective on national performance variation. DESIGN: To identify recent changes and variation in national hospital-level mortality and readmission for AMI, HF, and pneumonia, we performed cross-sectional panel analyses of national hospital performance on publicly reported measures. PARTICIPANTS: Fee-for-service Medicare and Veterans Health Administration beneficiaries, 65 years or older, hospitalized with principal discharge diagnoses of AMI, HF, or pneumonia between July 2009 and June 2012. RSMRs/RSRRs were calculated using hierarchical logistic models risk-adjusted for age, sex, comorbidities, and patients' clustering among hospitals. RESULTS: Median (range) RSMRs for AMI, HF, and pneumonia were 15.1% (9.4-21.0%), 11.3% (6.4-17.9%), and 11.4% (6.5-24.5%), respectively. Median (range) RSRRs for AMI, HF, and pneumonia were 18.2% (14.4-24.3%), 22.9% (17.1-30.7%), and 17.5% (13.6-24.0%), respectively. Median RSMRs declined for AMI (15.5% in 2009-2010, 15.4% in 2010-2011, 14.7% in 2011-2012) and remained similar for HF (11.5% in 2009-2010, 11.9% in 2010-2011, 11.7% in 2011-2012) and pneumonia (11.8% in 2009-2010, 11.9% in 2010-2011, 11.6% in 2011-2012). Median hospital-level RSRRs declined: AMI (18.5% in 2009-2010, 18.5% in 2010-2011, 17.7% in 2011-2012), HF (23.3% in 2009-2010, 23.1% in 2010-2011, 22.5% in 2011-2012), and pneumonia (17.7% in 2009-2010, 17.6% in 2010-2011, 17.3% in 2011-2012). CONCLUSIONS: We report the first national unplanned readmission results demonstrating declining rates for all three conditions between 2009-2012. Simultaneously, AMI mortality continued to decline, pneumonia mortality was stable, and HF mortality experienced a small increase.
Suter et al. (Tue,) conducted a cross-sectional in Acute Myocardial Infarction, Heart Failure, and Pneumonia. Hospitalization between July 2009 and June 2012 was evaluated on 30-day risk-standardized mortality rates (RSMRs) and risk-standardized unplanned readmission rates (RSRRs) (p=<0.001). Between 2009 and 2012, median 30-day risk-standardized unplanned readmission rates significantly declined for acute myocardial infarction (18.5% to 17.7%), heart failure (23.3% to 22.5%), and pneumonia (17.7% to 17.3%).