Risk-adjusted 30-day home time after heart failure hospitalization was inversely correlated with 30-day readmission (r=-0.23, P<0.001) and mortality (r=-0.31, P<0.001).
Cohort (n=2,968,341)
Yes
Does risk-adjusted 30-day home time serve as a valid hospital performance metric associated with readmission and mortality rates in patients discharged with heart failure?
Risk-adjusted 30-day home time is a patient-centered metric that correlates with traditional readmission and mortality rates and meaningfully reclassifies hospital performance for heart failure care.
Effect estimate: Correlation coefficient -0.23
p-value: p=< .001
Importance: Thirty-day home time, defined as time spent alive and out of a hospital or facility, is a novel, patient-centered performance metric that incorporates readmission and mortality. Objectives: To characterize risk-adjusted 30-day home time in patients discharged with heart failure (HF) as a hospital-level quality metric and evaluate its association with the 30-day risk-standardized readmission rate (RSRR), 30-day risk-standardized mortality rate (RSMR), and 1-year RSMR. Design, Setting, and Participants: This hospital-level cohort study retrospectively analyzed 100% of Medicare claims data from 2 968 341 patients from 3134 facilities from January 1, 2012, to November 30, 2017. Exposures: Home time, defined as time spent alive and out of a short-term hospital, skilled nursing facility, or intermediate/long-term facility 30 days after discharge. Main Outcomes and Measures: For each hospital, a risk-adjusted 30-day home time for HF was calculated similar to the Centers for Medicare 53.6% female) from 3134 hospitals were included in this study. The median hospital risk-adjusted 30-day home time for patients with HF was 21.77 days (range, 8.22-28.41 days). Hospitals in the highest quartile of risk-adjusted 30-day home time (best-performing hospitals) were larger (mean SD number of beds, 285 275), with a higher volume of patients with HF (median, 797 patients; interquartile range, 395-1484) and were more likely academic hospitals (59.9%) with availability of cardiac surgery (51.1%) and cardiac rehabilitation (68.8%). A total of 72% of home time lost was attributable to stays in an intermediate- or long-term care facility (mean SD, 2.65 6.44 days) or skilled nursing facility (mean SD, 3.96 9.04 days), 13% was attributable to short-term readmissions (mean SD, 1.25 3.25 days), and 15% was attributable to death (mean SD, 1.37 6.04 days). Among 30-day outcomes, the 30-day RSRR and 30-day RSMR decreased in a graded fashion across increasing 30-day home time categories (correlation coefficients: 30-day RSRR and 30-day home time, -0.23, P < .001; 30-day RSMR and 30-day home time, -0.31, P < .001). Similar patterns of association were also noted for 1-year RSMR and 30-day home time (correlation coefficient, -0.35, P < .001). Thirty-day home time meaningfully reclassified hospital performance in 30% of the hospitals compared with 30-day RSRR and in 25% of hospitals compared with 30-day RSMR. Conclusions and Relevance: In this study, 30-day home time among patients discharged after a hospitalization for HF was objectively assessed as a hospital-level quality metric using Medicare claims data and was associated with readmission and mortality outcomes and with reclassification of hospital performance compared with 30-day RSRR and 30-day RSMR.
Pandey et al. (2020) conducted a cohort in Heart failure (n=2,968,341). Risk-adjusted 30-day home time vs. 30-day RSRR and 30-day RSMR was evaluated on Correlation between hospital rates of risk-adjusted 30-day home time and 30-day RSRR (Correlation coefficient -0.23, p=< .001). Risk-adjusted 30-day home time after heart failure hospitalization was inversely correlated with 30-day readmission (r=-0.23, P<0.001) and mortality (r=-0.31, P<0.001).