High US readmission rates for heart failure and myocardial infarction
MedWire News: Analysis of new Medicare data shows that mortality rates for acute myocardial infarction (AMI) and heart failure (HF) vary across the USA, but that readmission rates are consistently high.
Study investigator Harlan Krumholz (Yale University School of Medicine, New Haven, Connecticut) and colleagues say their findings “represent a marked opportunity for improvement.”
They add: “The publication of these measures and the recognition of patterns of performance should lead to efforts to better understand the key determinants of performance and to improve patient outcomes.”
The Centers for Medicare & Medicaid Services provides the public with information on process of care, outcomes, and Medicare payment and volume for certain conditions, as well as patients’ hospital experiences.
The outcome measures now include 30-day mortality and 30-day readmission for AMI, HF, and pneumonia.
“The aim of this report is to complement the national release of the hospital-level AMI and HF measures by providing a descriptive summary of the variation in 30-day mortality and readmission rates by region and hospital characteristics,” Krumholz et al explain in the journal Circulation, Cardiovascular Quality and Outcomes.
Assessing all Medicare fee-for-service beneficiaries aged 65 years or older discharged between July 2005 and June 2008, they found that median 30-day mortality rate was 16.6% for AMI (range, 10.9–24.9%) and 11.1% for HF (range, 6.6–19.8%).
Meanwhile the median 30-day readmission rate was 19.9% for AMI (range, 15.3–29.4%) and 24.4% for HF (range, 15.9–34.4%).
There were marked geographic differences in performance across the country – for example, lower AMI and HF mortality was primarily localized in small, densely populated Hospital Referral Regions in the northeast.
Mortality and readmission rates for the two conditions tended to be better for teaching than non-teaching hospitals, although the range between the 10th and 90th percentile of the risk-standardized rate among the two groups showed considerable overlap.
“What is needed now is an investment in research that provides insight about how these rates can best be improve,” Krumholz et al comment.
“In some cases, such research may involve identifying top performers and investigating how they excel.”
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By Andrew Czyzewski