Abstract 17325: Association of Risk Adjusted 30 Day Heart Failure Readmission Rates Under the Hospital Readmissions Reduction Program With Quality of Care and Outcomes: Findings From the American Heart Association Get With the Guidelines-Heart Failure Program
Introduction: CMS Hospital Readmission Reduction Program (HRRP) penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates, defined as excess readmission ratio (ERR>1), for common conditions including HF. However, the association between this metric of hospital performance and measured quality of care and long-term outcomes is not known.
Methods: We analyzed data from the GWTG-HF registry linked to Medicare claims from 7/2008 through 6/2011. Using publicly available data on HF-ERR in 2013, we stratified the participating centers into groups with low vs. high risk-adjusted 30 day readmission rates for HF (HF-ERR ≤1 vs.>1 respectively). We compared the care quality and 1-year outcomes across the two groups in unadjusted and multivariable adjusted analysis.
Results: The analysis included 171 centers with 43,143 participants; 49% centers had high risk-adjusted 30-day readmission rates for HF (HF-ERR>1). There were no differences between the low vs. high HF-ERR groups in median adherence rate to all performance measures (95.7% vs. 96.5%, p=0.37) or median % defect-free care (90.0% vs. 91.1%, p=0.47). The composite 1-year outcome of death or all-cause readmission rates was also not different between the two groups (median: 62.9% vs. 65.3%; p=0.10). The low HF-ERR group had lower 1-year all-cause readmission rates (medians: 54.7% vs. 59.1%, p=0.01) . However, the 1-year mortality rates were higher among low vs. high HF-ERR group with a trend towards statistical significance (median: 31.7% vs. 28.2% ; p=0.07). Similar findings were also observed on multivariable adjusted logistic regression analysis with HF-ERR as a continuous variable (See Table).
Conclusion: Quality of care and clinical outcomes were comparable among hospitals with high vs. low risk-adjusted 30-day HF readmission rates. These findings raise questions about the validity of the HRRP performance metric in identifying and penalizing low performance centers.
Author Disclosures: A. Pandey: None. H. Golwala: None. H. Xu: None. A. DeVore: None. R. Matsouaka: None. M. Pencina: None. D. Kumbhani: None. A. Hernandez: None. D. Bhatt: None. P. Heidenreich: None. C. Yancy: None. J. De Lemos: Consultant/Advisory Board; Modest; Roche Diagnostics, Abbott Diagnostics. Research Grant; Significant; Abbott Diagnostics. Consultant/Advisory Board; Significant; Simen’s Health Care, Radiometer. G. Fonarow: None.
- © 2016 by American Heart Association, Inc.