Evaluation of 30-Day Hospital Readmission and Mortality Rates Using Regression-Discontinuity Framework

Khera, Rohan; Wang, Yongfei; Nasir, Khurram; Lin, Zhenqiu; Krumholz, Harlan M.

doi:10.1016/j.jacc.2019.04.060

Cited by 30 publications

(16 citation statements)

References 20 publications

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“…The reassuring findings from our study complement hospital level assessments, which have found that reductions in readmissions are on average associated with reductions in mortality 33. No evidence has been found to support the hypothesis of gaming of quality measures by delaying or deferring readmissions, as no discontinuities in readmission or mortality are seen around day 30 34…”

Section: Discussionsupporting

confidence: 61%

Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States

Khera

Wang

Bernheim

et al. 2020

BMJ

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Objectives To determine whether patients discharged after hospital admissions for conditions covered by national readmission programs who received care in emergency departments or observation units but were not readmitted within 30 days had an increased risk of death and to evaluate temporal trends in post-discharge acute care utilization in inpatient units, emergency departments, and observation units for these patients. Design Retrospective cohort study. Setting Medicare claims data for 2008-16 in the United States. Participants Patients aged 65 or older admitted to hospital with heart failure, acute myocardial infarction, or pneumonia—conditions included in the US Hospital Readmissions Reduction Program. Main outcome measures Post-discharge 30 day mortality according to patients’ 30 day acute care utilization; acute care utilization in inpatient and observation units and the emergency department during the 30 day and 31-90 day post-discharge period. Results 3 772 924 hospital admissions for heart failure, 1 570 113 for acute myocardial infarction, and 3 131 162 for pneumonia occurred. The overall post-discharge 30 day mortality was 8.7% for heart failure, 7.3% for acute myocardial infarction, and 8.4% for pneumonia. Risk adjusted mortality increased annually by 0.05% (95% confidence interval 0.02% to 0.08%) for heart failure, decreased by 0.06% (−0.09% to −0.04%) for acute myocardial infarction, and did not significantly change for pneumonia. Specifically, mortality increased for patients with heart failure who did not utilize any post-discharge acute care, increasing at a rate of 0.08% (0.05% to 0.12%) per year, exceeding the overall absolute annual increase in post-discharge mortality in heart failure, without an increase in mortality in observation units or the emergency department. Concurrent with a reduction in 30 day readmission rates, stays for observation and visits to the emergency department increased across all three conditions during and beyond the 30 day post-discharge period. Overall 30 day post-acute care utilization did not change significantly. Conclusions The only condition with increasing mortality through the study period was heart failure; the increase preceded the policy and was not present among patients who received emergency department or observation unit care without admission to hospital. During this period, the overall acute care utilization in the 30 days after discharge significantly decreased for heart failure and pneumonia, but not for acute myocardial infarction.

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Section: Discussionsupporting

confidence: 61%

Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States

Khera

Wang

Bernheim

et al. 2020

BMJ

Self Cite

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“…However, the patterns found in our study of increasing risk factor burden have been observed in the larger Medicare population after hospitalization for HF. 20 , 21 Furthermore, studies 18 , 19 , 52 that have focused on mortality trends in more recent years have found a similar pattern of stable to decreasing mortality after HF hospitalization. Notably, studies 20 , 21 , 53 that have investigated postdischarge mortality among Medicare beneficiaries with HF do not inform about the epidemiological trends in HF.…”

Section: Discussionmentioning

confidence: 86%

Temporal Trends in Heart Failure Incidence Among Medicare Beneficiaries Across Risk Factor Strata, 2011 to 2016

et al. 2020

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“…The CDC reports 6.5 million adults in the US have Heart failure (HF) with yearly costs topping 30 billion. HF patients admitted to Valley Baptist (VB) are readmitted 26% of the time, which is close to the national average of 23% (1). Standard of care for HF patients is remote nursing care for 30 days from discharge.…”

Section: Introductionmentioning

confidence: 95%

“…Supraja Thunuguntla (1), Michael Machiorlatti (2), Sonya Rivera (1), Juan Cortinas Galvan (1), Jose Campo Maldonado 11 UTRGV-SOM Department of Internal Medicine, Harlingen TX 2 UTRGV-SOM Department of Population Health and Biostatistics, Edinburgh TX…”

Section: Follow-up Care For Heart Failure Patients and Association Wimentioning

confidence: 99%

Follow-up Care for Heart Failure Patients and Association with Hospital Readmission

Thunuguntla

Galvan

Machiorlatti

et al. 2020

American Heart Journal

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Evaluation of 30-Day Hospital Readmission and Mortality Rates Using Regression-Discontinuity Framework

Cited by 30 publications

References 20 publications

Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States

Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States

Temporal Trends in Heart Failure Incidence Among Medicare Beneficiaries Across Risk Factor Strata, 2011 to 2016

Follow-up Care for Heart Failure Patients and Association with Hospital Readmission

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