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April 7, 2021JAMA CardiologyOpen Access

Association of Dual Eligibility for Medicare and Medicaid With Heart Failure Quality and Outcomes Among Get With The Guidelines–Heart Failure Hospitals

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Key result

Hospitals with the highest share of dual-eligible patients had higher 30-day all-cause readmissions compared with lowest-share hospitals (adjusted OR 1.24; 95% CI 1.14-1.35).

Why the study?

Little is known about the association of a hospital's share of Medicare-Medicaid dual-eligible beneficiaries with heart failure quality of care and outcomes under peer group-based payment systems.

Does admission to hospitals with a higher share of dual-eligible patients increase 30-day all-cause readmission in older patients with heart failure?

Population

258 995 hospitalized HF patients 65 years or older across 455 sites

Comparison

Hospitals grouped into quintiles based on their share of dual-eligible patients

Design

Retrospective cohort study

Follow-up

30 days

Authors

EBEhete BahiruBZBoback ZiaeianCMCorrina Moucheraud

Discussion

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Member takes

Overview

May warrant targeted quality efforts at safety-net hospitals; extends disparity data but leaves causality open for trials.

Study Design

Type

Cohort (n=258,995)

Multicenter

Yes

Structured PICO

Does admission to hospitals with a higher share of dual-eligible patients increase 30-day all-cause readmission in older patients with heart failure?

P
Population
258,995 patients aged 65 years or older hospitalized for heart failure across 455 sites, evaluated for the association between hospital dual-eligibility share and outcomes.
E
Exposure
Admission to hospitals in the highest quintile (quintile 5) of dual-eligible Medicare and Medicaid patients
C
Comparator
Admission to hospitals in the lowest quintile (quintile 1) of dual-eligible Medicare and Medicaid patients
O
Outcome
30-day all-cause readmissionhard clinical

Main Result

Odds Ratio: 1.24 (95% CI 1.14–1.35)

Hospitals caring for a higher proportion of dual-eligible Medicare and Medicaid patients have lower adherence to key heart failure process measures and higher 30-day readmission rates.

Cite This Study

Bahiru et al. (2021) conducted a cohort in Heart failure (n=258,995). High hospital share of dual-eligible patients (quintile 5) vs. Low hospital share of dual-eligible patients (quintile 1) was evaluated on 30-day all-cause readmission (OR 1.24, 95% CI 1.14-1.35). Hospitals with the highest share of dual-eligible patients had higher 30-day all-cause readmissions compared with lowest-share hospitals (adjusted OR 1.24; 95% CI 1.14-1.35).

synapsesocial.com/papers/6a69dedea03b17ebb0445763https://doi.org/10.1001/jamacardio.2021.0611
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Association of Medicaid Eligibility With Surgical Readmission Among Medicare Beneficiaries2020 · 19 citations
  2. 2Factors Associated With Disparities in Hospital Readmission Rates Among US Adults Dually Eligible for Medicare and Medicaid2022 · 13 citations
  3. 3Quality of Care and Clinical Outcomes for Patients With Heart Failure at Hospitals Caring for a High Proportion of Black Adults2023 · 6 citations
  4. 4Outcomes after ischemic stroke for dual-eligible Medicare-Medicaid beneficiaries in the United States2023 · 7 citations
  5. 5Association of the Affordable Care Act’s Medicaid Expansion With Care Quality and Outcomes for Low-Income Patients Hospitalized With Heart Failure2018 · 37 citations