30-Day Readmissions After Coronary Artery Bypass Graft Surgery in New York State

Hannan, Edward L.; Ye, Zhong; Lahey, Stephen J.; Culliford, Alfred T.; Gold, Jeffrey P.; Smith, Craig R.; Higgins, Robert S.D.; Jordan, D. C.; Wechsler, Andrew S.

doi:10.1016/j.jcin.2011.01.010

Cited by 218 publications

(217 citation statements)

References 11 publications

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“…Although we found a significant relationship between the CTM-3 and readmission within the PCI and total populations, we did not find a statistically significant relationship in the more debilitated CABG population. This 18 and many readmissions are not easily attributable to a single cause. 1,19 Therefore, even if the three domains of the CTM-3 were addressed equally for patients with PCI and CABG, their post transition experiences and ultimate reasons for readmission could vary greatly.…”

Section: And Readmissionmentioning

confidence: 94%

Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center

et al. 2016

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BACKGROUND: It is widely hypothesized that improvement in transitions of care will reduce unplanned hospital readmissions. However, the association between the Care Transitions Measure, the national quality metric for transitions of care and readmission risk, has not been established. OBJECTIVE: We aimed to determine the association between the Care Transition Measure and readmission. DESIGN: This was a single-center, prospective cohort study. PARTICIPANTS: Convenience sample of 2,963 patients enrolled in the BBridging the Divides^program, a longitudinal care management program for patients with coronary revascularization, from 2013 to 2014. Of these, 1594 (54 %) patients completed a post-discharge Care Transition Measure questionnaire. INTERVENTION: Care Transition Measure scores were collected by trained research staff blinded to study hypothesis, by telephone, within 30 days of discharge. Higher Care Transition Measure scores reflect a higher quality transition of care. MAIN MEASURES: 30-day readmission was measured. KEY RESULTS: Of the1594 patients that completed the Care Transition Measure survey, 1216 (76 %) received percutaneous coronary intervention and 378 (24 %) received coronary artery bypass grafting. Mean Care Transition Measure scores were significantly lower among patients who had a prior admission (77.2 vs. 82.1, p < 0.001) and those with ≥ 5 comorbidities (77 vs. 82.6 vs. 81.6, p < 0.001). Mean scores were significantly lower among patients who were readmitted within the percutaneous coronary intervention subgroup (73 vs. 80.9, p < 0.001) and the total study population (74.6 vs. 81.1, p < 0.001) compared to those who were not readmitted. This was not the case in the coronary artery bypass grafting subgroup (78.5 vs. 81.7, p = 0.29). After multivariable adjustment, every ten-point increase in the Care Transition Measure score was associated with a 14 % reduction in readmission risk (adjusted odds ratio 0.86, 95 % CI 0.78-0.95). CONCLUSIONS: The Care Transition Measure is strongly associated with readmissions, which strengthens its validity. However, its association with patient variables linked with readmission and its inconsistent association with readmission across clinical groups raises concerns that scores may be influenced by patient characteristics.

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Section: And Readmissionmentioning

confidence: 94%

Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center

et al. 2016

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“…21,22 The existence of wide variability in previous studies, the substantial variation observed in the current report, and the very low readmission rates achieved by some programs, 23,24 all suggest opportunities for improvement.…”

Section: Significant Interhospital Variation In Cabg Readmission Ratesmentioning

confidence: 61%

“…Among New York CABG patients from 1999, the overall readmission rate was 15.3%; 12.9% of patients were readmitted for reasons that appeared directly related to surgery. 11 In a follow-up study of patients from 2005 to 2007, 21 the comparable rates were even higher (16.5% and 14.3%, respectively).…”

Section: Lack Of Improvement In Cabg Readmission Ratesmentioning

confidence: 92%

“…Numerous studies 11,[18][19][20][21][22][24][25][26] have examined the causes and predictors of readmission after cardiac surgery, including CABG. Common reasons for readmission include wound infections; heart failure; arrhythmias; indeterminate chest pain, myocardial infarction, or angina; pneumonia or pleural effusions; stroke; sepsis; gastrointestinal complications; and renal failure.…”

Section: Improvement Opportunitiesmentioning

confidence: 99%

“…[20][21][22] This information may be helpful in identifying patients who may benefit from enhanced postdischarge follow-up.…”

Section: Improvement Opportunitiesmentioning

confidence: 99%

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Development of a Clinical Registry-Based 30-Day Readmission Measure for Coronary Artery Bypass Grafting Surgery

Shahian

O’Brien

et al. 2014

Circulation

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Background— Reducing readmissions is a major healthcare reform goal, and reimbursement penalties are imposed for higher-than-expected readmission rates. Most readmission risk models and performance measures are based on administrative rather than clinical data. Methods and Results— We examined rates and predictors of 30-day all-cause readmission following coronary artery bypass grafting surgery by using nationally representative clinical data (2008–2010) from the Society of Thoracic Surgeons National Database linked to Medicare claims records. Among 265 434 eligible Medicare records, 226 960 (86%) were successfully linked to Society of Thoracic Surgeons records; 162 572 (61%) isolated coronary artery bypass grafting admissions constituted the study cohort. Logistic regression was used to identify readmission risk factors; hierarchical regression models were then estimated. Risk-standardized readmission rates ranged from 12.6% to 23.6% (median, 16.8%) among 846 US hospitals with ≥30 eligible cases and ≥90% of eligible Centers for Medicare and Medicaid Services records linked to the Society of Thoracic Surgeons database. Readmission predictors (odds ratios [95% confidence interval]) included dialysis (2.02 [1.87–2.19]), severe chronic lung disease (1.58 [1.49–1.68]), creatinine (2.5 versus 1.0 or lower:1.49 [1.41–1.57]; 2.0 versus 1.0 or lower: 1.37 [1.32–1.43]), insulin-dependent diabetes mellitus (1.45 [1.39–1.51]), obesity in women (body surface area 2.2 versus 1.8: 1.44 [1.35–1.53]), female sex (1.38 [1.33–1.43]), immunosuppression (1.38 [1.28–1.49]), preoperative atrial fibrillation (1.36 [1.30–1.42]), age per 10-year increase (1.36 [1.33–1.39]), recent myocardial infarction (1.24 [1.08–1.42]), and low body surface area in men (1.22 [1.14–1.30]). C-statistic was 0.648. Fifty-two hospitals (6.1%) had readmission rates statistically better or worse than expected. Conclusions— A coronary artery bypass grafting surgery readmission measure suitable for public reporting was developed by using the national Society of Thoracic Surgeons clinical data linked to Medicare readmission claims.

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Determinants, Associations, Consequences, and Prevention of Readmissions After Transcatheter Aortic Valve Replacement

Carroll

2017

JAMA Cardiol

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30-Day Readmissions After Coronary Artery Bypass Graft Surgery in New York State

Cited by 218 publications

References 11 publications

Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center

Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center

Development of a Clinical Registry-Based 30-Day Readmission Measure for Coronary Artery Bypass Grafting Surgery

Determinants, Associations, Consequences, and Prevention of Readmissions After Transcatheter Aortic Valve Replacement

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