Hospital Strategies Associated With 30-Day Readmission Rates for Patients With Heart Failure

被引：269

作者：

Bradley, Elizabeth H. ^{[1
,4
]}

Curry, Leslie ^{[1
,4
]}

Horwitz, Leora I. ^{[2
,4
,5
]}

Sipsma, Heather

Wang, Yongfei ^{[3
,4
,5
]}

Walsh, Mary Norine ^{[6
]}

Goldmann, Don ^{[7
,8
,9
]}

White, Neal ^{[10
]}

Pina, Ileana L. ^{[11
]}

Krumholz, Harlan M. ^{[1
,3
,4
,5
]}

机构：

[1] Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06520 USA

[2] Yale Univ, Sch Med, Gen Internal Med Sect, Dept Med, New Haven, CT 06520 USA

[3] Yale Univ, Sch Med, Sect Cardiovas Med, New Haven, CT 06520 USA

[4] Yale Univ, Sch Med, Dept Med, New Haven, CT 06520 USA

[5] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA

[6] St Vincents Heart Ctr, Indianapolis, IN USA

[7] Inst Healthcare Improvement, Dept Pediat, Cambridge, MA USA

[8] Childrens Hosp Boston, Dept Pediat, Boston, MA USA

[9] Harvard Univ, Sch Med, Boston, MA USA

[10] John Muir Hlth Syst, Dept Cardiol, Walnut Creek, CA USA

[11] Albert Einstein Coll Med, Montefiore Einstein Med Cardiovasc Ctr, Bronx, NY 10467 USA

来源：

CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES | 2013年 / 6卷 / 04期

关键词：

heart failure; patient readmission; quality improvement; ACUTE MYOCARDIAL-INFARCTION; CARE TRANSITIONS INTERVENTION; RANDOMIZED CONTROLLED-TRIAL; CLINICAL-TRIAL; FOLLOW-UP; HIGH-RISK; DISCHARGE; REHOSPITALIZATION; PERFORMANCE; OUTCOMES;

D O I：

10.1161/CIRCOUTCOMES.111.000101

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Reducing hospital readmission rates is a national priority; however, evidence about hospital strategies that are associated with lower readmission rates is limited. We sought to identify hospital strategies that were associated with lower readmission rates for patients with heart failure. Methods and Results Using data from a Web-based survey of hospitals participating in national quality initiatives to reduce readmission (n=599; 91% response rate) during 2010-2011, we constructed a multivariable linear regression model, weighted by hospital volume, to determine strategies independently associated with risk-standardized 30-day readmission rates (RSRRs) adjusted for hospital teaching status, geographic location, and number of staffed beds. Strategies that were associated with lower hospital RSRRs included the following: (1) partnering with community physicians or physician groups to reduce readmission (0.33% percentage point lower RSRRs; P=0.017), (2) partnering with local hospitals to reduce readmissions (0.34 percentage point; P=0.020), (3) having nurses responsible for medication reconciliation (0.18 percentage point; P=0.002), (4) arranging follow-up appointments before discharge (0.19 percentage point; P=0.037), (5) having a process in place to send all discharge paper or electronic summaries directly to the patient's primary physician (0.21 percentage point; P=0.004), and (6) assigning staff to follow up on test results that return after the patient is discharged (0.26 percentage point; P=0.049). Although statistically significant, the magnitude of the effects was modest with individual strategies associated with less than half a percentage point reduction in RSRRs; however, hospitals that implemented more strategies had significantly lower RSRRs (reduction of 0.34 percentage point for each additional strategy). Conclusions Several strategies were associated with lower hospital RSRRs for patients with heart failure.

引用

页码：444 / 450

页数：7

共 37 条

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