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Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission.

Abstract：

BACKGROUND:In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures. METHODS AND RESULTS:We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008. We compared weighted risk-standardized mortality and readmission rates across Hospital Referral Regions and hospital structural characteristics. The median 30-day mortality rate was 16.6% for AMI (range, 10.9% to 24.9%; 25th to 75th percentile, 15.8% to 17.4%; 10th to 90th percentile, 14.7% to 18.4%) and 11.1% for HF (range, 6.6% to 19.8%; 25th to 75th percentile, 10.3% to 12.0%; 10th to 90th percentile, 9.4% to 13.1%). The median 30-day readmission rate was 19.9% for AMI (range, 15.3% to 29.4%; 25th to 75th percentile, 19.5% to 20.4%; 10th to 90th percentile, 18.8% to 21.1%) and 24.4% for HF (range, 15.9% to 34.4%; 25th to 75th percentile, 23.4% to 25.6%; 10th to 90th percentile, 22.3% to 27.0%). We observed geographic differences in performance across the country. Although there were some differences in average performance by hospital characteristics, there were high and low hospital performers among all types of hospitals. CONCLUSIONS:In a recent 3-year period, 30-day risk-standardized mortality rates for AMI and HF varied among hospitals and across the country. The readmission rates were particularly high.

journal_name

Circ Cardiovasc Qual Outcomes

journal_title

Circulation. Cardiovascular quality and outcomes

authors

Krumholz HM,Merrill AR,Schone EM,Schreiner GC,Chen J,Bradley EH,Wang Y,Wang Y,Lin Z,Straube BM,Rapp MT,Normand SL,Drye EE

doi

10.1161/CIRCOUTCOMES.109.883256

subject

Has Abstract

pub_date

2009-09-01 00:00:00

pages

407-13

issue

eissn

1941-7713

issn

1941-7705

pii

CIRCOUTCOMES.109.883256

journal_volume

pub_type

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Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission.