Abstract 14912: Preventability of 30-Day Readmission After PCI
Introduction: Early readmission after PCI is an important contributor to health care expenditures, and a target for performance measurement. The extent to which 30-day readmissions after PCI are preventable and the concordance of this assessment by independent clinician raters is unknown, but important for improving this outcome.
Methods: PCI patients readmitted within 30 days of discharge at the Massachusetts General Hospital (January 2007-December 2011) and Brigham and Women’s Hospital (June 2009-December 2011), were identified, and their medical records independently reviewed by 2 physicians. The reviewers used an ordinal scale (Not, Possibly, Probably and Definitely preventable) to rate preventability. Physician agreement was assessed using a kappa statistic.
Results: Of 9288 PCIs performed, 9081 patients (97.8%) survived to initial hospital discharge, and 1012 (11.1%) were readmitted to the index hospital within 30 days. After excluding repeat readmissions, 894 readmissions were reviewed. One reviewer rated 601 readmissions (67.2%) “not preventable,” 59 readmissions (6.6%) “possibly preventable,” 83 readmissions (9.3%) “probably preventable,” and 151 readmissions (16.9%) “definitely preventable.” The other reviewer rated 477 readmissions “not preventable,” (53.4%) 115 readmissions “possibly preventable,” (12.9%), 107 readmissions (12.0%) “probably preventable,” and 195 readmissions (21.8%) “definitely preventable.” Both reviewers rated 99 readmissions (11.1%) “definitely preventable.” The kappa statistic was 0.34 [95% CI: 0.30-0.38], indicating fair agreement between physician reviewers.
Conclusions: While over half of readmissions after PCI are not believed to be preventable, between a third to a half are potentially preventable and reducing these events could markedly improve the costs and risks to patients. The modest agreement by physicians warrants further efforts to understand the preventability of readmissions.
- © 2013 by American Heart Association, Inc.