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JAMA Cardiol. 2017 Jul 1;2(7):723-731. doi: 10.1001/jamacardio.2017.1143.

Association of US Centers for Medicare and Medicaid Services Hospital 30-Day Risk-Standardized Readmission Metric With Care Quality and Outcomes After Acute Myocardial Infarction: Findings From the National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines.

Author information

1
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas.
2
Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts.
3
Duke Clinical Research Institute, Durham, North Carolina.
4
Duke Clinical Research Institute, Durham, North Carolina4Department of Neurology, Duke University Medical Center, Durham, North Carolina.
5
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
6
Division of Cardiology, Columbia University School of Medicine, New York, New York.
7
Ronald Reagan-UCLA Medical Center, Los Angeles, California8Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology.

Abstract

Importance:

The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penalizes hospitals with higher-than-expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR] > 1) after acute myocardial infarction (MI). However, the association of ERR with MI care processes and outcomes are not well established.

Objective:

To evaluate the association between ERR for MI with in-hospital process of care measures and 1-year clinical outcomes.

Design, Setting, and Participants:

Observational analysis of hospitalized patients with MI from National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines centers subject to the first cycle of the Hospital Readmissions Reduction Program between July 1, 2008, and June 30, 2011.

Exposures:

The ERR for MI (MI-ERR) in 2011.

Main Outcomes and Measures:

Adherence to process of care measures during index hospitalization in the overall study population and risk of the composite outcome of mortality or all-cause readmission within 1 year of discharge and its individual components among participants with available Centers for Medicare and Medicaid Services-linked data.

Results:

The median ages of patients in the MI-ERR greater than 1 and tertiles 1, 2, and 3 of the MI-ERR greater than 1 groups were 64, 63, 64, and 63 years, respectively. Among 380 hospitals that treated a total of 176 644 patients with MI during the study period, 43% had MI-ERR greater than 1. The proportions of patients of black race, those with heart failure signs at admission, and bleeding complications increased with higher MI-ERR. There was no significant association between adherence to MI performance measures and MI-ERR (adjusted odds ratio, 0.94; 95% CI, 0.81-1.08, per 0.1-unit increase in MI-ERR for overall defect-free care). Among the 51 453 patients with 1-year outcomes data available, higher MI-ERR was associated with higher adjusted risk of the composite outcome and all-cause readmission within 1 year of discharge. This association was largely driven by readmissions early after discharge and was not significant in landmark analyses beginning 30 days after discharge. The MI-ERR was not associated with risk for mortality within 1 year of discharge in the overall and 30-day landmark analyses.

Conclusions and Relevance:

During the first cycle of the Hospital Readmissions Reduction Program, participating hospitals' risk-adjusted 30-day readmission rates following MI were not associated with in-hospital quality of MI care or clinical outcomes occurring after the first 30 days after discharge.

PMID:
28445559
PMCID:
PMC5815085
DOI:
10.1001/jamacardio.2017.1143
[Indexed for MEDLINE]
Free PMC Article

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