Study examines hospital readmission and mortality rates for Medicare patients
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 mortality rates (RSMRs) for patients with acute myocardial infarction [AMI; heart attack] and heart failure (HF) in June 2007 and for pneumonia in 2008. In June 2009, the CMS expanded public reporting to include hospital 30-day, all-cause, risk-standardized-readmission rates (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 Medicare 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 heart failure, 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
Provided by JAMA and Archives Journals
- Doctors' decisions on initial hospital admissions may affect readmission rates May 13, 2011 | not rated yet | 0
- Death rate decreases following hospitalization for heart attack Aug 18, 2009 | not rated yet | 0
- Hospital strategies linked to lower mortality after acute MI May 01, 2012 | not rated yet | 0
- Hospital readmission rates linked to availability of care, socioeconomics May 11, 2012 | not rated yet | 0
- Improved staffing cuts medicare patient readmissions Jan 04, 2013 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
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 20 hours ago | not rated yet | 0
(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 22 hours ago | not rated yet | 0
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 May 24, 2013 | not rated yet | 0
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 May 24, 2013 | not rated yet | 0
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 May 24, 2013 | 3 / 5 (1) | 0
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 ...
5 hours ago | 5 / 5 (1) | 4
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.
May 24, 2013 | 3.7 / 5 (3) | 4 |
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 ...
5 hours ago | not rated yet | 1
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 ...
21 hours ago | 3 / 5 (2) | 0 |
(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 ...
5 hours ago | not rated yet | 0
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 ...
5 hours ago | not rated yet | 0