In the Journals

Readmission rates for HF, MI decreased after Medicare program implemented

Rohan Khera

After the Hospital Readmissions Reduction Program was announced in 2010 and implemented in 2012, there were decreases in readmissions and increases in observation stays and ED visits 30 days postdischarge in patients previously hospitalized for HF, acute MI or pneumonia, according to a study published in The BMJ.

HF was the only condition for which mortality increased during a study period of 2008 to 2016, which preceded policy implementation and was not observed in patients who were seen in the ED or at the observation unit without hospital admission, according to the study.

“The study reaffirms that current clinical care practices are aligned with the needs of the patient,” Rohan Khera, MD, second-year clinical fellow in the division of cardiology at University of Texas Southwestern Medical Center in Dallas, told Healio. “Therefore, the restructuring of care practices with increasing use of observation units to care for patients has not resulted in patient harm as has been speculated. Moreover, our study also suggests that some of the increase in mortality in HF may reflect appropriate triage of end-of-life care from the in-hospital setting to the postdischarge period and hospice facilities.”

Researchers analyzed data from the Medicare Standard Analytic Files of inpatient and outpatient claims from 2008 to 2016. Patients included were aged 65 years and older who were hospitalized with a principal discharge diagnosis of acute MI, HF or pneumonia. In total, there were 1,570,113 hospital admissions for acute MI, 3,772,924 for HF and 3,131,162 for pneumonia.

Overall postdischarge mortality at 30 days was 7.3% for acute MI, 8.7% for HF and 8.4% for pneumonia. Average risk-adjusted postdischarge mortality at 30 days decreased by 0.06% per year for acute MI (95% CI, –0.09 to –0.04) and increased by 0.05% per year for HF (95% CI, 0.02-0.08). No significant changes were observed for pneumonia.

The rate of increase in patients with HF who did not utilize postdischarge acute care increased by 0.08% per year (95% CI, 0.05-0.12), which exceeded the overall increase seen for postdischarge mortality in HF. There were no increases in mortality in the ED or observation units.

During the 30-day postdischarge period and beyond, there were increases in ED visits and observation stays for all three conditions. Significant changes were not seen for overall postacute care utilization at 30 days.

“Further research is focused on elucidating strategies to account for patient wishes and goals of care in understanding the effects of health policy interventions,” Khera said in an interview. “Prior studies, including ours, only focus on crude trends in outcomes and suggest certain mechanism. However, future research would need to be designed to isolate the effects of patient choices on how we evaluate their outcomes.” – by Darlene Dobkowski

For more information:

Rohan Khera, MD, can be reached at rohankhera@outlook.com; Twitter: @rohan_khera.

Disclosures: Khera reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Rohan Khera

After the Hospital Readmissions Reduction Program was announced in 2010 and implemented in 2012, there were decreases in readmissions and increases in observation stays and ED visits 30 days postdischarge in patients previously hospitalized for HF, acute MI or pneumonia, according to a study published in The BMJ.

HF was the only condition for which mortality increased during a study period of 2008 to 2016, which preceded policy implementation and was not observed in patients who were seen in the ED or at the observation unit without hospital admission, according to the study.

“The study reaffirms that current clinical care practices are aligned with the needs of the patient,” Rohan Khera, MD, second-year clinical fellow in the division of cardiology at University of Texas Southwestern Medical Center in Dallas, told Healio. “Therefore, the restructuring of care practices with increasing use of observation units to care for patients has not resulted in patient harm as has been speculated. Moreover, our study also suggests that some of the increase in mortality in HF may reflect appropriate triage of end-of-life care from the in-hospital setting to the postdischarge period and hospice facilities.”

Researchers analyzed data from the Medicare Standard Analytic Files of inpatient and outpatient claims from 2008 to 2016. Patients included were aged 65 years and older who were hospitalized with a principal discharge diagnosis of acute MI, HF or pneumonia. In total, there were 1,570,113 hospital admissions for acute MI, 3,772,924 for HF and 3,131,162 for pneumonia.

Overall postdischarge mortality at 30 days was 7.3% for acute MI, 8.7% for HF and 8.4% for pneumonia. Average risk-adjusted postdischarge mortality at 30 days decreased by 0.06% per year for acute MI (95% CI, –0.09 to –0.04) and increased by 0.05% per year for HF (95% CI, 0.02-0.08). No significant changes were observed for pneumonia.

The rate of increase in patients with HF who did not utilize postdischarge acute care increased by 0.08% per year (95% CI, 0.05-0.12), which exceeded the overall increase seen for postdischarge mortality in HF. There were no increases in mortality in the ED or observation units.

During the 30-day postdischarge period and beyond, there were increases in ED visits and observation stays for all three conditions. Significant changes were not seen for overall postacute care utilization at 30 days.

“Further research is focused on elucidating strategies to account for patient wishes and goals of care in understanding the effects of health policy interventions,” Khera said in an interview. “Prior studies, including ours, only focus on crude trends in outcomes and suggest certain mechanism. However, future research would need to be designed to isolate the effects of patient choices on how we evaluate their outcomes.” – by Darlene Dobkowski

For more information:

Rohan Khera, MD, can be reached at rohankhera@outlook.com; Twitter: @rohan_khera.

Disclosures: Khera reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.