A Retrospective Analysis of all-cause 30-day readmissions among patients with Heart Failure at Emory University Hospitals Pubblico

Abstract

A Retrospective Analysis of all-cause 30-day readmissions among patients with Heart Failure at Emory University Hospitals

By Lakshmi Peddareddy

Background:

Heart Failure (HF) is a serious concern in the United States as it carries huge financial burden and high patient morbidity and mortality. One in 4 patients with HF diagnosis are readmitted within 30 days of discharge. As excessive readmissions tend to indicate suboptimal care, the Hospital Readmission Reduction Program (HRRP) was introduced to make hospitals responsible. Through this program since 2013, Medicare started to penalize the hospitals that exceed the national average readmission rates by reducing the Medicare reimbursements for inpatient services from 1% to a maximum of 3%. Despite reduction in readmission rate, multiple concerns were raised by hospitals and other stakeholders, like the American Hospital Association (AHA), that not all readmissions are preventable, readmission rate alone does not indicate the quality of care of a hospital, the formula to calculate readmission rate does not take factors like socioeconomic status into consideration, and the rate is a national average rate and not specific to hospitals. To verify some of these concerns we wanted to evaluate the all-cause 30-day readmissions among a subset of heart failure patients at Emory University Hospitals and to identify the predictors for preventable vs non preventable readmissions.

Objective:

To evaluate the all-cause 30-day readmissions among the heart failure patients and to identify predictors for preventable and non-preventable readmissions.

Methods:

We retrospectively examined the electronic charts of patients admitted to Emory Hospitals (Emory University Hospital at Clifton; Emory University Hospital at Midtown) with primary diagnosis of HF since January 1, 2012, until 100 consecutive subjects with all-cause 30-day readmission were identified. We collected data on patients' demographic variables, cause of admission, treatment and discharge at the time of admission, prior admissions, and presence of comorbid conditions. For study purposes, we classified Preventable Causes for Readmission as readmissions resulting from inadequate treatment of HF during initial admission, inadequate care for other comorbid conditions during hospitalization like diabetes and lack of adequate discharge teaching /Plan, and Non-Preventable Causes for Readmission as readmissions resulting from natural progression of HF, worsening of comorbid conditions despite adequate treatment during discharge of initial admission , subjects noncompliance to diet and medication and subjects socioeconomic status, lack of social support. We used odds ratios from univariate logistic regression analysis using SAS (9.4) to examine the association of factors for preventable readmissions and compare to non-preventable readmissions.

Results:

Of 100 readmissions in patients with HF, we classified 14 as preventable and 86 as non-preventable. The characteristics of patients with preventable and non-preventable were similar except for Insurance. 86% of preventable readmission patients carried Medicare insurance compared to 62% among non-preventable readmission patients. Among the 14 preventable readmissions, 8 (57%) readmissions were because of inadequate treatment of HF during initial admission; 1 (7%) because of inadequate care for other comorbid conditions during hospitalization; and 5 (36%) because of lack of discharge teaching /plan.

Conclusion:

The results are consistent with existing literature showing that inadequate treatment and inadequate discharge plan at the time of discharge are 2 major causes for preventable readmissions in HF. In this study patients that carried Medicare insurance were more likely to have higher readmission rates than patients that carried commercial insurance.

Table of Contents

Table of Contents

1. Introduction 1

Statement of the Problem 3

Theoretical Framework 6

Statement of Purpose 7

Research Question 8

Statement of Significance 8

Protocol Definitions 9

2. Methods 11

Design 11

Population 11

Data Acquisition and Storage 12

Protection of Human Subjects 12

Data Analysis 13

3. Results 15

4. Discussion 18

Findings 18

Strengths and Limitations 20

Recommendations for Future and Conclusion 21

Appendices 23

References 27

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Parola chiave	Hospital Readmission Reduction Program non preventive readdmissions Medicare Penalties preventive readmissions All cause 30-day readmission Heart Failure
Committee Chair / Thesis Advisor	Merchant, Faisal M, Emory University Alonso, Alvaro , Emory University
Committee Members	Gaydos, Laurie, Emory University
Partnering Agencies	Hospital or other health care provider

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