Abstract 4018: Redefining Readmissions to Better Reflect the Clinical Course of Heart Failure Patients
Background Associated with high mortality and morbidity, heart failure readmissions (HFR) represent potential targets for interventions. HFR is used by payors, hospitals, and physicians as a surrogate for quality of care. It is necessary to clearly define a HFR in a way such that it represents a valid indicator of clinical course and quality of care. The most common definition of a HFR, an admission that occurs within a specified time frame after discharge from an index admission (Method 1), may be misleading. If an admissions were to occur close to, but outside, a specified time frame, it would not be classified as a HFR. In the long term, the effect of the index admissions intervention will wane, making it less appropriate to classify a hospitalization as an HFR. We propose an alternative definition of HFR (Method 2) and describe its effect on the HFR percentages of a large clinical database of HF inpatients (n=3,318).
Methods and Results Method 2 compares each HF admission with the immediately previous HF admission; if it occurs within the specified time frame, the admission is classified as a HFR. Otherwise, it is labeled an index admission, to be compared with the next admission. By examining each hospitalization as a potential index admission or HFR, a more comprehensive assessment of the clinical picture may be obtained. To compare 30 and 180 day HFRs using both definitions, we analyzed 3,318 patients with 8,043 HF related admissions to 5 hospitals. Method 2 classifies larger percentages of admissions over the 2 year study period as HFRs at both 30 and 180 day time frames. Similarly, a greater percentage of patients have HFRs using method 2. (See table⇓) Length of stay for 30 day HFRs are 6.1 days using method 1 vs. 7.3 for method 2.
Conclusion Our proposed alternative to the traditional method of defining an HFR paints a more comprehensive picture of the clinical course after discharge. When using HFRs to monitor quality and cost of HF care, method 2 outperforms the traditional definition of HFR.