Recent national trends in readmission rates after heart failure hospitalization

Abstract

Background: In July 2009, Medicare began publicly reporting hospitals' risk-standardized 30-day all-cause readmission rates (RSRRs) among fee-for-service beneficiaries discharged after hospitalization for heart failure from all the US acute care nonfederal hospitals. No recent national trends in RSRRs have been reported, and it is not known whether hospital-specific performance is improving or variation in performance is decreasing.

Methods and results: We used 2004-2006 Medicare administrative data to identify all fee-for-service beneficiaries admitted to a US acute care hospital for heart failure and discharged alive. We estimated mean annual RSRRs, a National Quality Forum-endorsed metric for quality, using 2-level hierarchical models that accounted for age, sex, and multiple comorbidities; variation in quality was estimated by the SD of the RSRRs. There were 570 996 distinct hospitalizations for heart failure in which the patient was discharged alive in 4728 hospitals in 2004, 544 550 in 4694 hospitals in 2005, and 501 234 in 4674 hospitals in 2006. Unadjusted 30-day all-cause readmission rates were virtually identical over this period: 23.0% in 2004, 23.3% in 2005, and 22.9% in 2006. The mean and SD of RSRRs were also similar: mean (SD) of 23.7% (1.3) in 2004, 23.9% (1.4) in 2005, and 23.8% (1.4) in 2006, suggesting similar hospital variation throughout the study period.

Conclusions: National mean and RSRR distributions among Medicare beneficiaries discharged after hospitalization for heart failure have not changed in recent years, indicating that there was neither improvement in hospital readmission rates nor in hospital variations in rates over this time period.

Conflict of interest statement

Conflicts of interest: Drs. Chen, Lin, Curtis, Normand, Wang, Wang, and Krumholz and Mr. Schreiner report that they developed RSRRs for heart failure under contract with the Colorado Foundation for Medical Care. Dr. Krumholz reports that he chairs a scientific advisory board for UnitedHealthcare.

Figures

Figure 1. Frequency distribution of RSRRs for fee-for-service Medicare beneficiaries discharged after heart failure hospitalization, 2004–2006

Note: The upper boundaries of the boxes represent the seventy-fifth percentile, the lines bisecting the boxes represent the median or fiftieth percentile, and the lower boundaries of the boxes represent the twenty -fifth percentile. The upper and lower boundaries of the whiskers are set at 1.5 * IQR above the seventy-fifth percentile and at 1.5 * IQR below the twenty-fifth percentile respectively, with dots representing hospitals beyond these percentiles at the extreme.

Figure 2. Frequency distribution of RSRRs for fee-for-service Medicare beneficiaries discharged after heart failure hospitalization by Census Division, 2004–2006

Note: The left-most boundaries of the narrow boxes represent the seventy-fifth percentile, the lines bisecting the narrow boxes represent the median or fiftieth percentile, and the right-most lower boundaries of the boxes represent the twenty -fifth percentile. The left-most and right-most boundaries of the whiskers are set at 1.5 * IQR below the twenty-fifth percentile and 1.5 * IQR above the seventy-fifth percentile respectively. Hospitals beyond these percentiles at the extreme were excluded from this Figure.