Subject(s)
Cardiology/legislation & jurisprudence , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Episode of Care , Heart Diseases/therapy , Insurance, Health, Reimbursement/legislation & jurisprudence , Medicare/legislation & jurisprudence , Policy Making , Cardiology/economics , Centers for Medicare and Medicaid Services, U.S./economics , Government Regulation , Health Care Reform/economics , Health Care Reform/legislation & jurisprudence , Heart Diseases/diagnosis , Heart Diseases/economics , Humans , Insurance, Health, Reimbursement/economics , Medicare/economics , Program Development , Program Evaluation , United StatesABSTRACT
BACKGROUND: Reducing hospital readmissions for patients with heart failure is a national priority, and quality improvement campaigns are targeting reductions of ≥20%. However, there are limited data on whether such targets have been met. METHODS AND RESULTS: We analyzed data from the American Heart Association's Get With The Guidelines-Heart Failure registry linked to Medicare claims between 2009 and 2012 to describe trends and relative reduction of rates of 30-day all-cause readmission among patients with heart failure. A total of 21,264 patients with heart failure were included from 70 US sites from January 2009 to October 2012. Overall hospital-level, risk-adjusted, 30-day all-cause readmission rates declined slightly, from 20.0% (SD, 1.3%) in 2009 to 19.0% (SD, 1.2%) in 2012 (P=0.001). Only 1 in 70 (1.4%) hospitals achieved the 20% relative reduction in 30-day risk-adjusted readmission rates. A multivariable linear regression model was used to determine hospital-level factors associated with relative improvements in 30-day risk-adjusted readmissions between 2009 and 2012. Teaching hospitals had higher relative readmission rates as compared with their peers, and hospitals that used postdischarge heart failure disease management programs had lower relative readmission rates. CONCLUSIONS: Although there has been slight improvement in 30-day all-cause readmission rates during the past 4 years in patients with heart failure, few hospitals have seen large success.
