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.


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 <or=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.
Polanczyk
C A
CA
Heart Failure and Cardiac Transplantation Unit, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Newton
C
C
Dec
G W
GW
Di Salvo
T G
TG
D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D002309:Cardiology / Q000706:statistics & numerical data; D016507:Cardiology Service, Hospital / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D016019:Survival Analysis