title: National survey of hospital strategies to reduce heart failure readmissions: findings from the Get With the Guidelines-Heart Failure registry.
abstract: BACKGROUND
  Reducing 30-day heart failure readmission rates is a national priority. Yet, little is known about how hospitals address the problem and whether hospital-based processes of care are associated with reductions in readmission rates.
  
  
  RESULTS
  We surveyed 100 randomly selected hospitals participating in the Get With the Guidelines-Heart Failure quality improvement program regarding common processes of care aimed at reducing readmissions. We grouped processes into 3 domains (ie, inpatient care, discharge and transitional care, and general quality improvement) and scored hospitals on the basis of survey responses using processes selected a priori. We used linear regression to examine associations between these domain scores and 30-day risk-standardized readmission rates. Of the 100 participating sites, 28% were academic centers and 64% were community hospitals. The median readmission rate among participating sites (24.0%; 95% CI, 22.6%-25.7%) was comparable with the national average (24.6%; 23.5-25.9). Sites varied substantially in care processes used for inpatient care, education, discharge process, care transitions, and quality improvement. Overall, neither inpatient care nor general quality improvement domains were associated with 30-day readmission rates. Hospitals in the lowest readmission rate quartile had modestly higher discharge and transitional care domain scores (P=0.03).
  
  
  CONCLUSIONS
  A variety of strategies are used by hospitals in an attempt to improve 30-day readmission rates for patients hospitalized with heart failure. Although more complete discharge and transitional care processes may be modestly associated with lower 30-day readmission rates, most current strategies are not associated with lower readmission rates.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA. rkociol@tuftsmedicalcenter.org
authors.forename: Robb D
authors.initials: RD
authors.lastname: Kociol
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Flynn
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Lytle
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D003266:Continuity of Patient Care; D003625:Data Collection; D017408:Guidelines as Topic; D006333:Heart Failure; D006801:Humans; D016014:Linear Models; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement; D011787:Quality of Health Care; D012042:Registries / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior; D014481:United States