Document Detail

Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia.
MedLine Citation:
PMID:  23403683     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: The Centers for Medicare & Medicaid Services publicly reports hospital 30-day, all-cause, risk-standardized mortality rates (RSMRs) and 30-day, all-cause, risk-standardized readmission rates (RSRRs) for acute myocardial infarction, heart failure, and pneumonia. The evaluation of hospital performance as measured by RSMRs and RSRRs has not been well characterized.
OBJECTIVE: To determine the relationship between hospital RSMRs and RSRRs overall and within subgroups defined by hospital characteristics.
DESIGN, SETTING, AND PARTICIPANTS: We studied Medicare fee-for-service beneficiaries discharged with acute myocardial infarction, heart failure, or pneumonia between July 1, 2005, and June 30, 2008 (4506 hospitals for acute myocardial infarction, 4767 hospitals for heart failure, and 4811 hospitals for pneumonia). We quantified the correlation between hospital RSMRs and RSRRs using weighted linear correlation; evaluated correlations in groups defined by hospital characteristics; and determined the proportion of hospitals with better and worse performance on both measures.
RESULTS: Mean RSMRs and RSRRs, respectively, were 16.60% and 19.94% for acute myocardial infarction, 11.17% and 24.56% for heart failure, and 11.64% and 18.22% for pneumonia. The correlations between RSMRs and RSRRs were 0.03 (95% CI, -0.002 to 0.06) for acute myocardial infarction, -0.17 (95% CI, -0.20 to -0.14) for heart failure, and 0.002 (95% CI, -0.03 to 0.03) for pneumonia. The results were similar for subgroups defined by hospital characteristics. Although there was a significant negative linear relationship between RSMRs and RSRRs for heart failure, the shared variance between them was only 2.9% (r2 = 0.029), with the correlation most prominent for hospitals with RSMR <11%.
CONCLUSION AND RELEVANCE: Risk-standardized mortality rates and readmission rates were not associated for patients admitted with an acute myocardial infarction or pneumonia and were only weakly associated, within a certain range, for patients admitted with heart failure.
Harlan M Krumholz; Zhenqiu Lin; Patricia S Keenan; Jersey Chen; Joseph S Ross; Elizabeth E Drye; Susannah M Bernheim; Yun Wang; Elizabeth H Bradley; Lein F Han; Sharon-Lise T Normand
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-13     Completed Date:  2013-02-19     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  587-93     Citation Subset:  AIM; IM    
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MeSH Terms
Cohort Studies
Fee-for-Service Plans / statistics & numerical data
Heart Failure / mortality*,  therapy
Hospital Mortality / trends*
Hospitals / classification,  statistics & numerical data*
Medicare / statistics & numerical data
Mortality / trends
Myocardial Infarction / mortality*,  therapy
Patient Discharge / statistics & numerical data
Patient Readmission / statistics & numerical data*
Pneumonia / mortality*,  therapy
Quality Indicators, Health Care
Risk Adjustment
United States
Grant Support
K08 AG032886/AG/NIA NIH HHS; K08 AG032886-05/AG/NIA NIH HHS; K08 HS018781-03/HS/AHRQ HHS; U01 HL105270/HL/NHLBI NIH HHS; U01 HL105270-03/HL/NHLBI NIH HHS

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