Study examines hospital readmission and mortality rates for Medicare patients

February 12, 2013 in Health

In a study that included data on nearly 3 million hospital admissions for Medicare beneficiaries with heart attack, pneumonia or heart failure, researchers failed to find evidence that a hospital's performance on the measure for 30-day mortality rates was strongly associated with performance on 30-day readmission rates, findings that may lessen concerns that hospitals with lower mortality rates will have higher readmission rates, according to a study appearing in the February 13 issue of JAMA.

"Measuring and improving hospital quality of care, particularly outcomes of care, is an important focus for clinicians and policy makers. The Centers for Medicare & Medicaid Services (CMS) began publicly reporting hospital 30-day, all-cause, risk-standardized (RSMRs) for patients with acute myocardial infarction [AMI; ] and heart failure (HF) in June 2007 and for in 2008. In June 2009, the CMS expanded public reporting to include hospital 30-day, all-cause, risk-standardized- (RSRRs) for patients hospitalized with these 3 conditions," according to background information in the article. "The mortality and readmission measures have been proposed for use in federal programs to modify hospital payments based on performance."

Some researchers have raised concerns that these rates might have an inverse relationship, such that hospitals with lower mortality rates are more likely to have higher readmission rates. "Interventions that improve mortality might also increase readmission rates by resulting in a higher-risk group being discharged from the hospital. Conversely, the measures could provide redundant information. … Limited information exists about this relationship, an understanding of which is critical to measurement of quality, and yet questions surrounding an inverse relationship have led to public concerns about the measures."

Harlan M. Krumholz, M.D., S.M., of the Yale University School of Medicine, New Haven, Conn., and colleagues investigated the relationship between hospital RSMRs and RSRRs overall and within subgroups defined by hospital characteristics. The study included fee-for-service beneficiaries discharged between July 2005 and June 2008. For AMI, the sample for final analysis consisted of 4,506 hospitals with 590,809 admissions for mortality and 586,027 readmissions; for HF, 4,767 hospitals with 1,161,179 admissions for mortality and 1,430,030 readmissions; and for pneumonia, 4,811 hospitals with 1,225,366 admissions for mortality and 1,297,031 readmissions.

The researchers found that average RSMRs and RSRRs, respectively, were 16.60 percent and 19.94 percent for heart attack, 11.17 percent and 24.56 percent for heart failure, and 11.64 percent and 18.22 percent for pneumonia. The correlations between RSMRs and RSRRs were 0.03 for acute myocardial infarction, -0.17 for , and 0.002 for pneumonia. In subgroup analyses, the correlations between RSMRs and RSRRs did not differ substantially in any of the subgroups of hospital types, including hospital region, safety net status, and urban/rural status.

"In a national study of the CMS publicly reported outcomes measures, we failed to find evidence that a hospital's performance on the measure for 30-day RSMR is strongly associated with performance on 30-day RSRR," the authors write. "For AMI and pneumonia, there was no discernible relationship, and for HF, the relationship was only modest and not throughout the entire range of performance."

"Our findings indicate that many institutions do well on mortality and readmission and that performance on one does not dictate performance on the other."

More information: JAMA 2013;309(6):587-593

Journal reference: Journal of the American Medical Association search and more info website

Provided by JAMA and Archives Journals search and more info website

not rated yet  

Rank not rated yet
Relevant PhysicsForums posts

More news stories

Driving and hands-free talking lead to spike in errors, study shows

Talking on a hands-free device while behind the wheel can lead to a sharp increase in errors that could imperil other drivers on the road, according to new research from the University of Alberta.

Health created 20 hours ago | popularity not rated yet | comments 0

About one in four uninsured could be excluded from ACA

(HealthDay)—More than one in four of those eligible for new premium assistance tax credits under the Affordable Care Act (ACA) do not have a checking account and will not be able to receive premiums from ...

Health created 22 hours ago | popularity not rated yet | comments 0

Audiologists recommend smart phone apps to monitor noise levels

After studying noise in one French Quarter neighborhood of New Orleans to determine whether or not noise levels exceeded municipal ordinances, Annette Hurley, PhD, Assistant Professor of Audiology at LSU Health Sciences Center ...

Health created May 24, 2013 | popularity not rated yet | comments 0

Young children who miss well-child visits are more likely to be hospitalized

Young children who missed more than half of recommended well-child visits had up to twice the risk of hospitalization compared to children who attended most of their visits, according to a study published today in the American Jo ...

Health created May 24, 2013 | popularity not rated yet | comments 0

Do doctors understand the individualisation of treatments?

The individualisation of drug treatments to support patients to self-manage their conditions is a concept that sits at the heart of policy, but a recent study in BMJ Open shows that there is no concrete defini ...

Health created May 24, 2013 | popularity 3 / 5 (1) | comments 0


First drug to improve heart failure mortality in over a decade

Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...

Hormone levels may provide key to understanding psychological disorders in women

Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.

Heart failure accelerates male 'menopause'

Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...

Researchers identify first drug targets in childhood genetic tumor disorder

Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...

Feds fight morning-after pill age ruling in NY

(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...

Death highest in heart failure patients admitted in January, on Friday, and overnight

Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...