Abstract 17432: Association of Hospital Excess Readmission Ratio With Care Quality and Outcomes After Acute Myocardial Infarction: Findings From the NCDR ACTION Registry-GWTG
Introduction: The Hospital Readmission Reduction Program (HRRP) penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]>1) after acute myocardial infarction (AMI). However, the association of ERR with AMI care processes and outcomes are not well established.
Methods: All AMI patients from NCDR ACTION Registry-GWTG centers subject to the first cycle of HRRP between 07/01/2008 and 06/30/2011 were included. Participating centers were stratified into 4 data-derived categories of MI-ERR: MI-ERR≤1 and tertiles of centers with MI-ERR > 1. Patient characteristics, adherence to AMI performance measures, and overall defect-free care were compared. Adjusted associations between continuous measure of MI-ERR and risk of adverse clinical outcomes at 1 year (mortality and all-cause readmission) were assessed using in the subset of patients with CMS-linked claims data.
Results: We included 380 centers (43% with MI-ERR>1) enrolling a total of 176,644 AMI patients, of which 51,453 patients had CMS-linked outcomes data. The proportion of black patients, CHF signs at admission, bleeding complications and in-hospital length of stay all increased across categories of higher ERR (Table). There were no meaningful trends in adherence to AMI performance measures and overall defect-free care across ERR groups (Table). In adjusted analysis, higher ERR (among hospitals with MI-ERR> 1) was significantly associated with greater risk of 1-year all-cause readmission [hazard ratio (HR, 95% CI): 1.04 (1.01 – 1.07) per 0.1 unit increase in ERR]. However, overall defect free care and 1-year mortality rates were not associated with ERR [(HR 95% CI): 1.00 (0.95 – 1.05) per 0.1 unit increase in ERR).
Conclusion: During the 1st cycle of HRRP, participating centers’ risk-adjusted 30-day readmission rates following AMI were associated with 1-year readmission rates, but not with in-hospital quality of AMI care or 1-year mortality rates.
Author Disclosures: A. Pandey: None. H. Golwala: None. H. Hall: None. T. Wang: None. D. Lu: None. Y. Xian: None. K. Chiswell: None. K. Joynt: None. A. Goyal: None. S. Das: None. D. Kumbhani: None. H. Julien: None. G. Fonarow: 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.
- © 2016 by American Heart Association, Inc.