Thirty-Day Readmissions for Critical Limb Ischemia
Ready for a New Quality Metric?
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Article, see p 167
Since Charles Dotter performed the first balloon angioplasty for critical limb ischemia (CLI),1 there have been myriad advances in the treatment of patients with peripheral arterial disease. Primary and secondary prevention measures, supervised exercise programs, and revascularization strategies, including surgical, endovascular, and hybrid approaches, have dramatically evolved, leading to improved patient outcomes. CLI represents the most complex and advanced stage of peripheral arterial disease and is associated with considerable morbidity and mortality and significant consumption of healthcare resources, particularly during admissions and subsequent readmissions.2 The initiation of the Hospital Readmission Reduction Program in 2012, as a part of the Affordable Care Act, heralded an era of cost consciousness and quality metrics, with a particular emphasis on hospital readmissions as a quality and performance metric for hospitals.3 Although the 30-day readmission metric may not necessarily reflect the actual quality of care delivered during the index admission, financial penalties against hospitals with excessive readmissions within 30 days of discharge for Medicare beneficiaries have led to intense scrutiny of in-hospital patient care, postdischarge planning, and drivers of readmissions. Initially, conditions known to have a high risk of readmissions such as congestive heart failure, myocardial infarction, and pneumonia were targeted. Given its high readmission prevalence, CLI may soon become a target of the Hospital Readmissions Reduction Program. Further data on the incidence, predictors, and reasons for 30-day readmission after hospitalization for CLI can assist policy makers in designing quality metrics and reimbursement policies as payment reforms are being implemented.
In this issue of the Circulation, Kolte et al4 attempt to address these issues by conducting a thorough examination of unplanned readmissions in 60 998 index hospitalizations with a primary diagnosis of CLI during which patients underwent endovascular or surgical therapy (revascularization and/or amputation) in the 2013 …