Details

Autor(en) / Beteiligte

• Fonarow, Gregg C.
• Konstam, Marvin A.
• Yancy, Clyde W.

Titel

The Hospital Readmission Reduction Program Is Associated With Fewer Readmissions, More Deaths: Time to Reconsider

Ist Teil von

• Journal of the American College of Cardiology, 2017-10, Vol.70 (15), p.1931-1934

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Has there been unintentional harm in the deployment of this process (5-14)? Because deaths without hospitalization favorably affect the HRRP metric, it should be considered a metric of utilization, not quality. The other side of the statistical correlation reported is that hospitals with no change or increasing 30-day readmissions rates, and thus facing greater HRRP financial penalties, had increases in 30-day post-discharge mortality. [...]with HRRP implementation nationally, 30-day risk-adjusted post-discharge mortality in Medicare beneficiaries hospitalized with HF increased from 7.9% in 2008 to 9.2% in 2014 (19). Furthermore, the HRRP has created additional financial incentives for hospitals to document more comorbid conditions and greater complexity (up-coding), which is further facilitated by electronic health records, to improve risk-adjusted rates (21). [...]it is also possible that this strategy has artificially made the reductions in risk-standardized 30-day readmission appear greater than they actually were and has artificially underestimated the increases in risk-adjusted mortality for HF that may have occurred. 3 A. Vidic, J.T. Chibnall, P.J. Hauptman, Heart failure is a major contributor to hospital readmission penalties, J Card Fail, Vol. 21, 2015, 134-137 4 P.S. Keenan, S.L. Normand, Z. Lin, An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure, Circ Cardiovasc Qual Outcomes, Vol. 1, 2008, 29-37 5 R. Bhalla, G. Kalkut, Ann Intern Med, Vol. 152, 2010, 114-117 6 E.Z. Gorodeski, R.C. Starling, E.H. Blackstone, N Engl J Med, Vol. 363, 2010, 297-298 7 K.E. Joynt, E.J. Orav, A.K. Jha, Thirty-day readmission rates for Medicare beneficiaries by race and site of care, JAMA, Vol. 305, 2011, 675-681 8 M.D. Naylor, E.T. Kurtzman, D.C. Grabowski, C. Harrington, M. McClellan, S.C. Reinhard, Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults, Health Aff (Millwood), Vol. 31, 2012, 1623-1632 9 M.J. Press, D.P. Scanlon, A.M. Ryan, Limits of readmission rates in measuring hospital quality suggest the need for added metrics, Health Aff (Millwood), Vol. 32, 2013, 1083-1091 10 K.E. Joynt, A.K. Jha, Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program, JAMA, Vol. 309, 2013, 342-343 11 M. Gilman, J.M. Hockenberry, E.K. Adams, A.S. Milstein, I.B. Wilson, E.R. Becker, The financial effect of value-based purchasing and the hospital readmissions reduction program on safety-net hospitals in 2014: a cohort study, Ann Intern Med, Vol. 163, 2015, 427-436 12 M.L. Barnett, J. Hsu, J.M. McWilliams, Patient characteristics and differences in hospital readmission rates, JAMA Intern Med, Vol. 175, 2015, 1803-1812 13 M.A. Konstam, J. Upshaw, Sisyphus and 30-day heart failure readmissions: futility in predicting a flawed outcome metric, J Am Coll Cardiol HF, Vol. 4, 2016, 21-23 14 D. Kansagara, H. Englander, A. Salanitro, Risk prediction models for hospital readmission: a systematic review, JAMA, Vol. 306, 2011, 1688-1698 15 A. Pandey, H. Golwala, H. Xu, Association of 30-day readmission metric for heart failure under the hospital readmissions reduction program with quality of care and outcomes, J Am Coll Cardiol HF, Vol. 4, 2016, 935-946 16 P.A. Heidenreich, A. Sahay, J.R. Kapoor, M.X. Pham, B. Massie, 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, Vol. 56, 2010, 362-368 17 N.R. Desai, J.S. Ross, J.Y. Kwon, Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions, JAMA, Vol. 316, 2016, 2647-2656 18 R.B. Zuckerman, S.H. Sheingold, E.J. Orav, J. Ruhter, A.M. Epstein, Readmissions, Observation, and the Hospital Readmissions Reduction Program, N Engl J Med, Vol. 374, 2016, 1543-1551 19 K. Dharmarajan, Y. Wang, Z. Lin, Association of changing hospital readmission rates with mortality rates after hospital discharge, JAMA, Vol. 318, 2017, 270-278 20 H.M. Krumholz, S.L. Normand, Y. Wang, Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke, 1999-2011, Circulation, Vol. 130, 2014, 966-975 21 A.K. Jha, Seeking rational approaches to fixing hospital readmission, JAMA, Vol. 314, 2015, 1681-1682