Abstract 18716: 30-Day All-Cause Readmission After Percutaneous Coronary Intervention in Massachusetts: Clinical Predictors and Hospital-Variation of a New Quality Metric
Background: Early readmission after discharge has been identified as a preventable source of healthcare expenditures across a broad spectrum of diseases. The National Quality Forum has proposed adopting 30-day all-cause readmission after PCI as a quality measure. Few studies have examined the etiology and predictors of readmission after PCI or variation of rates between hospitals.
Methods: We examined 30-day all-cause readmission after PCI among all adult in-hospital survivors in Massachusetts between 10/2005 through 9/2007. Clinical and angiographic variables for readmitted and non-readmitted patients were compared. Stepwise selection was performed on a-priori selected variables to identify a parsimonious set of readmission predictors. Hospital crude readmission rates were compared, and hierarchical logistic regression was used to generate risk-standardized readmission rates (RSRRs) for each hospital.
Results: Among 25,358 PCI admissions at 22 Massachusetts' hospitals, there were 3139 30-day readmissions (12.4%). Hospital readmission rates varied from 8.0% to 19.8%. The most common diagnoses for readmission were ischemic heart disease (24%), respiratory disease (13%), heart failure (7%), MI (4%) and dysrhythmia (3%). Predictors of readmission included history of CHF, age, emergency or salvage PCI, and diabetes. RSRRs varied across hospitals (Figure), with the odds of readmission for a patient undergoing PCI at a hospital one SD above the state average being 1.5 (95% CI: 1.3, 1.9) times that for a patient undergoing PCI at a hospital one SD below the state average.
Conclusions: All-cause 30-day readmission rates after PCI varied among Massachusetts' hospitals, and, after accounting for patient characteristics, between-hospital variation remained large. Hospitals with high readmission rates may benefit from the selective targeting of patients predicted to be at high risk for readmission based on clinical factors.
- © 2010 by American Heart Association, Inc.