Heart failure rehospitalization of the Medicare FFS patient: a state-level analysis exploring 30-day readmission factors.
OBJECTIVE
Heart failure readmission among the elderly is frequent and costly to both the patient and the Medicare trust fund. In this study, the authors explore the factors that are associated with states having heart failure readmission rates that are higher than the U.S. national rate.


METHODS
Acute inpatient hospital settings.


METHODS
50 state-level data and multivariate regression analysis is used. The dependent variable Heart Failure 30-day Readmission Worse than U.S. Rate is based on adult Medicare Fee-for-Service patients hospitalized with a primary discharge diagnosis of heart failure and for which a subsequent inpatient readmission occurred within 30 days of their last discharge.


RESULTS
One key variable found--states with a higher resident population speaking a primary language other than English at home--that is significantly associated with a decrease in probability in states ranking "worse" on heart failure 30-day readmission. Whereas, states with a higher median income, more total days of care per 1,000 Medicare enrollees, and a greater percentage of Medicare enrollees with prescription drug coverage have a greater probability for heart failure 30-day readmission to be "worse" than the U.S. national rate.


CONCLUSIONS
Case management interventions targeting health literacy may be more effective than other factors to improve state-level hospital status on heart failure 30-day readmission. Factors such as total days of care per 1,000 Medicare enrollees and improving patient access to postdischarge medication(s) may not be as important as literacy. Interventions aimed to prevent disparities should consider higher income population groups as vulnerable for readmission.
Department of Political Science, Kent State University, Kent, OH 44224, USA. mschmeid@kent.edu
Mary
M
Schmeida
Ronald A
RA
Savrin
D000208:Acute Disease; D019090:Case Management; D005260:Female; D006333:Heart Failure; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014481:United States