Clinical InvestigationHeart FailureAre we targeting the right metric for heart failure? Comparison of hospital 30-day readmission rates and total episode of care inpatient days
Section snippets
Data source
We obtained clinical data from GWTG-HF for patients 65 years or older. Hospitals participating in GWTG-HF submit clinical information regarding the medical history, hospital care, and outcomes of consecutive patients hospitalized for coronary artery disease, stroke, or HF using an online, interactive case-report form and Patient Management Tool (Outcome Sciences, Inc, Cambridge, MA). Through their Patient Management Tool, Outcome Sciences, Inc, serves as the data collection and coordination
Results
The study included 17,387 patients 65 years or older enrolled in GWTG-HF. We included 149 hospitals. The median hospital-level 30-day readmission rate was 23.2 (interquartile range [IQR] 19.1-26.3). The median observed hospital-level index admission LOS and overall EOC were 4.9 (IQR 4.2-5.6) and 6.2 (IQR 5.3-7.4) days, respectively. Among those readmitted, the median observed LOS for the second hospitalization was 5.0 days (IQR 3.0-8.0 days) and was not significantly different than the index
Discussion
The current emphasis on quality improvement and cost containment for highly prevalent chronic health conditions makes HF an ideal focus point.2, 13 Understanding how to measure efficiency, resource use, and quality of care among hospitals treating patients with HF will be central to this effort.14 Related to this, our analysis yields several important findings. First, although variation exists in both hospital-level LOS and EOC, we demonstrate an increased variation in the latter. Second,
Disclosures
The Get With The Guidelines-Heart Failure (GWTG-HF) program is provided by the American Heart Association. The GWTG-HF program is currently supported, in part, by Medtronic, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. GWTG-HF has been funded in the past through support from GlaxoSmithKline.
This project received infrastructure support from the Agency for Healthcare Research and Quality (Grant No. U18HS016964). The content is solely the responsibility of the
Acknowledgements
The authors would like to thank Erin LoFrese for her editorial contributions to this manuscript. Ms LoFrese did not receive compensation for her assistance, apart from her employment at the institution where the study was conducted.
References (25)
- et al.
Associations between worsening renal function and 30-day outcomes among Medicare beneficiaries hospitalized with heart failure
Am Heart J
(2010) - et al.
Linking inpatient clinical registry data to Medicare claims data using indirect identifiers
Am Heart J
(2009) - et al.
Effect of compliance with quality performance measures for heart failure on clinical outcomes in high-risk patients
J Natl Med Assoc
(2010) - et al.
Divergent trends in survival and readmission following a hospitalization for heart failure in the Veterans Affairs health care system 2002 to 2006
J Am Coll Cardiol
(2010) - et al.
Associations of patient demographic characteristics and regoinal physician density with early physician follow-up among Medicare beneficiaries hospitalized with heart failure
Am J Cardiol
(2011) - et al.
Heart disease and stroke statistics—2010 update: a report from the American Heart Association
Circulation
(2010) - et al.
Rehospitalizations among patients in the Medicare fee-for-service program
N Engl J Med
(2009) - et al.
Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure
JAMA
(2010) Revisiting readmissions—changing the incentives for shared accountability
N Engl J Med
(2009)- et al.
Public reporting of discharge planning and rates of readmissions
N Engl J Med
(2009)
Effect of DRGs on three-month readmission rate of geriatric patients with congestive heart failure
Am J Public Health
Implications of DRGs for clinicians
N Engl J Med
Cited by (48)
Clinical utility of antigen carbohydrate 125 for planning the optimal length of stay in acute heart failure
2021, European Journal of Internal MedicineHeart Failure Outcomes With Volume-Guided Management
2018, JACC: Heart FailureCitation Excerpt :The increase in LOS among volume-guided admissions must be contextualized by the reduction in 30-day readmissions. Given current Medicare reimbursement incentives and inpatient management objectives from a cost control perspective, emphasis should be placed on discharging patients as soon as possible and minimizing rehospitalizations (34–37). The benefit of individualized care guided by BVA appears unrestricted by EF category.
Home-Time After Discharge Among Patients Hospitalized With Heart Failure
2018, Journal of the American College of CardiologyTrends, causes and timing of 30-day readmissions after hospitalization for heart failure: 11-year population-based analysis with linked data
2017, International Journal of Cardiology
- f
and the Get With The Guidelines Steering Committee and Hospitals.