National patterns of risk-standardized mortality and readmission for acute myocardial infarction and heart failure. Update on publicly reported outcomes measures based on the 2010 release.
BACKGROUND
Patient outcomes provide a critical perspective on quality of care. The Centers for Medicare and Medicaid Services (CMS) is publicly reporting hospital 30-day risk-standardized mortality rates (RSMRs) and risk-standardized readmission rates (RSRRs) for patients hospitalized with acute myocardial infarction (AMI) and heart failure (HF). We provide a national perspective on hospital performance for the 2010 release of these measures.


RESULTS
The hospital RSMRs and RSRRs are calculated from Medicare claims data for fee-for-service Medicare beneficiaries, 65 years or older, hospitalized with AMI or HF between July 1, 2006, and June 30, 2009. The rates are calculated using hierarchical logistic modeling to account for patient clustering, and are risk-adjusted for age, sex, and patient comorbidities. The median RSMR for AMI was 16.0% and for HF was 10.8%. Both measures had a wide range of hospital performance with an absolute 5.2% difference between hospitals in the 5th versus 95th percentile for AMI and 5.0% for HF. The median RSRR for AMI was 19.9% and for HF was 24.5% (3.9% range for 5th to 95th percentile for AMI, 6.7% for HF). Distinct regional patterns were evident for both measures and both conditions.


CONCLUSIONS
High RSRRs persist for AMI and HF and clinically meaningful variation exists for RSMRs and RSRRs for both conditions. Our results suggest continued opportunities for improvement in patient outcomes for HF and AMI.
Bernheim
Susannah M
SM
Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation, 1 Church Street, New Haven, CT 06510, USA. susannah.bernheim@yale.edu
Grady
Jacqueline N
JN
Lin
Zhenqiu
Z
Wang
Yun
Y
Wang
Yongfei
Y
Savage
Shantal V
SV
Bhat
Kanchana R
KR
Ross
Joseph S
JS
Desai
Mayur M
MM
Merrill
Angela R
AR
Han
Lein F
LF
Rapp
Michael T
MT
Drye
Elizabeth E
EE
Normand
Sharon-Lise T
SL
Krumholz
Harlan M
HM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000639:trends; D011785:Quality Assurance, Health Care; D012306:Risk; D014481:United States