We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge.
- Authors
Dharmarajan, Kumar; Yongfei Wang; Zhenqiu Lin; Normand, Sharon-Lise T.; Ross, Joseph S.; Horwitz, Leora I.; Desai, Nihar R.; Suter, Lisa G.; Drye, Elizabeth E.; Bernheim, Susannah M.; Krumholz, Harlan M.; Wang, Yongfei; Lin, Zhenqiu
- Abstract
<bold>Importance: </bold>The Affordable Care Act has led to US national reductions in hospital 30-day readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Whether readmission reductions have had the unintended consequence of increasing mortality after hospitalization is unknown.<bold>Objective: </bold>To examine the correlation of paired trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge.<bold>Design, Setting, and Participants: </bold>Retrospective study of Medicare fee-for-service beneficiaries aged 65 years or older hospitalized with HF, AMI, or pneumonia from January 1, 2008, through December 31, 2014.<bold>Exposure: </bold>Thirty-day risk-adjusted readmission rate (RARR).<bold>Main Outcomes and Measures: </bold>Thirty-day RARRs and 30-day risk-adjusted mortality rates (RAMRs) after discharge were calculated for each condition in each month at each hospital in 2008 through 2014. Monthly trends in each hospital's 30-day RARRs and 30-day RAMRs after discharge were examined for each condition. The weighted Pearson correlation coefficient was calculated for hospitals' paired monthly trends in 30-day RARRs and 30-day RAMRs after discharge for each condition.<bold>Results: </bold>In 2008 through 2014, 2 962 554 hospitalizations for HF, 1 229 939 for AMI, and 2 544 530 for pneumonia were identified at 5016, 4772, and 5057 hospitals, respectively. In January 2008, mean hospital 30-day RARRs and 30-day RAMRs after discharge were 24.6% and 8.4% for HF, 19.3% and 7.6% for AMI, and 18.3% and 8.5% for pneumonia. Hospital 30-day RARRs declined in the aggregate across hospitals from 2008 through 2014; monthly changes in RARRs were -0.053% (95% CI, -0.055% to -0.051%) for HF, -0.044% (95% CI, -0.047% to -0.041%) for AMI, and -0.033% (95% CI, -0.035% to -0.031%) for pneumonia. In contrast, monthly aggregate changes across hospitals in hospital 30-day RAMRs after discharge varied by condition: HF, 0.008% (95% CI, 0.007% to 0.010%); AMI, -0.003% (95% CI, -0.005% to -0.001%); and pneumonia, 0.001% (95% CI, -0.001% to 0.003%). However, correlation coefficients in hospitals' paired monthly changes in 30-day RARRs and 30-day RAMRs after discharge were weakly positive: HF, 0.066 (95% CI, 0.036 to 0.096); AMI, 0.067 (95% CI, 0.027 to 0.106); and pneumonia, 0.108 (95% CI, 0.079 to 0.137). Findings were similar in secondary analyses, including with alternate definitions of hospital mortality.<bold>Conclusions and Relevance: </bold>Among Medicare fee-for-service beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia, reductions in hospital 30-day readmission rates were weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge. These findings do not support increasing postdischarge mortality related to reducing hospital readmissions.
- Subjects
UNITED States; PATIENT readmissions; DEATH rate; HOSPITAL admission &; discharge; PATIENT Protection &; Affordable Care Act; MEDICARE; PNEUMONIA-related mortality; HEART failure; HOSPITAL care; MORTALITY; MYOCARDIAL infarction; RISK assessment; DISCHARGE planning; RETROSPECTIVE studies; FEE for service (Medical fees)
- Publication
JAMA: Journal of the American Medical Association, 2017, Vol 318, Issue 3, p270
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2017.8444