Abstract P319: Which Types of Hospitals Have Higher Readmission Rates for Heart Failure

• Published in: Circulation Cardiovascular quality and outcomes Vol. 4; no. suppl_1
• Main Authors: Joynt, Karen E, Jha, Ashish K
• Format: Journal Article
• Language: English
• Published: 01.11.2011
• ISSN: 1941-7713; 1941-7705
• DOI: 10.1161/circoutcomes.4.suppl_1.AP319

Abstract only Reducing readmissions is an important policy goal, and heart failure (HF) is the most common cause of both hospitalizations and readmissions in the Medicare program. Most proposed policy changes involve penalizing poorly-performing hospitals, yet we know little about what kinds of U.S. hospitals have high readmission rates, and therefore might be at particularly high risk of facing financial penalties. We created multivariable regression models using Medicare inpatient data from 2006-2007 to examine the relationship between hospital characteristics and 30-day all-cause readmission rates for patients with a primary discharge diagnosis of HF. Given that many pay-for-performance programs penalize poor performers based on categorical cutpoints, we also examined the likelihood that a hospital would be in the worst quartile or decile of readmission rates nationally. Among the 4,010 hospitals in our sample, critical access hospitals and small hospitals had significantly higher 30-day readmission rates than medium or large hospitals ( Table ). Hospitals not part of a system had higher readmission rates than hospitals that were members of systems, and both public hospitals and for-profit hospitals had higher readmission rates than private non-profit hospitals. These same hospitals were far more likely to perform in the bottom quartile or decile nationally (Table). Consequently, these hospitals will be at significantly higher risk of payment reductions if cut-points are used to target institutions for penalties. Given that some of the most resource-poor hospitals in the country are among the worst performers for HF readmissions, quality improvement efforts that rely on penalties and rewards may further widen the quality gap. Concerted efforts are needed to understand why these hospitals perform poorly, why the top hospitals perform well, and how best to design interventions to improve the quality of care for all HF patients, regardless of where they seek medical care. Hospital Characteristics 30-day readmission rate P value OR (95% CI) for worst quartile P value OR (95% CI) for worst decile P value Hospital Type Critical Access 28.2% <0.001 12.4 (7.2, 21.4) <0.001 12.5 (4.3, 36.6) <0.001 Small 27.1% 8.1 (4.9, 13.6) <0.001 8.9 (3.1, 25.4) <0.001 Medium 25.4% 3.0 (1.8, 4.8) <0.001 2.4 (0.9, 6.6) 0.10 Large 24.2% 1.0 Ref 1.0 Ref Hospital System Non-member 26.5% 0.048 1.2 (1.0, 1.4) 0.02 1.5 (1.2, 1.9) 0.002 Member 26.0% 1.0 Ref 1.0 Ref Ownership For-profit 27.0% <0.001 1.7 (1.3, 2.1) <0.001 1.6 (1.1, 2.3) 0.007 Public 26.7% 1.3 (1.0. 1.5) 0.02 1.3 (1.0, 1.7) 0.03 Non-profit 25.7% 1.0 Ref 1.0 Ref