Quality of care and hospital readmission in congestive heart failure: An explicit review process

Background: The effect of hospital quality of care on hospital readmission for patients with congestive heart failure (CHF) has not been widely studied. Methods and Results: We examined the effects of clinical factors, hospital quality of care, and cardiologist involvement on 3-month readmission rates in patients with CHF by using a 125-item explicit review instrument comprising 3 major domains: admission work-up, evaluation and treatment, and readiness for discharge. During the 3 months after discharge, 59 (30%) of 205 patients were readmitted for CHF. The average evaluation and treatment score was lower for readmitted patients (63% v 58%; P = .04). The specific quality criteria differing between patients readmitted or not readmitted included the performance of any diagnostic evaluation, performance of echocardiography in patients with unknown ejection fraction or suspected valvular disease, and therapy with an angiotensin-converting enzyme inhibitor on discharge. Patients with less than or equal to 50% of the evaluation and treatment criteria met were more likely to be readmitted (odds ratio, 2.5; 95% confidence interval, 1.1-5.3; P = .02). In a multivariate model including both clinical characteristics and quality criteria, a low evaluation and treatment score was an independent predictor of readmission. Cardiologist involvement was correlated with higher quality-of-care scores in the admission work-up (4.8% higher; P < .01) and evaluation and treatment (8.6% higher; P < .0001). Conclusions: Hospital quality of care for patients with CHF is independently associated with 3-month readmission rates, and cardiologist involvement during hospitalization is associated with overall quality of care.