title: Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia.
abstract: OBJECTIVE
  The Centers for Medicare & Medicaid Services publicly reports hospital 30-day, all-cause, risk-standardized mortality rates (RSMRs) and 30-day, all-cause, risk-standardized readmission rates (RSRRs) for acute myocardial infarction, heart failure, and pneumonia. The evaluation of hospital performance as measured by RSMRs and RSRRs has not been well characterized.
  
  
  OBJECTIVE
  To determine the relationship between hospital RSMRs and RSRRs overall and within subgroups defined by hospital characteristics.
  
  
  METHODS
  We studied Medicare fee-for-service beneficiaries discharged with acute myocardial infarction, heart failure, or pneumonia between July 1, 2005, and June 30, 2008 (4506 hospitals for acute myocardial infarction, 4767 hospitals for heart failure, and 4811 hospitals for pneumonia). We quantified the correlation between hospital RSMRs and RSRRs using weighted linear correlation; evaluated correlations in groups defined by hospital characteristics; and determined the proportion of hospitals with better and worse performance on both measures.
  
  
  METHODS
  Hospital 30-day RSMRs and RSRRs.
  
  
  RESULTS
  Mean RSMRs and RSRRs, respectively, were 16.60% and 19.94% for acute myocardial infarction, 11.17% and 24.56% for heart failure, and 11.64% and 18.22% for pneumonia. The correlations between RSMRs and RSRRs were 0.03 (95% CI, -0.002 to 0.06) for acute myocardial infarction, -0.17 (95% CI, -0.20 to -0.14) for heart failure, and 0.002 (95% CI, -0.03 to 0.03) for pneumonia. The results were similar for subgroups defined by hospital characteristics. Although there was a significant negative linear relationship between RSMRs and RSRRs for heart failure, the shared variance between them was only 2.9% (r2 = 0.029), with the correlation most prominent for hospitals with RSMR <11%.
  
  
  CONCLUSIONS
  Risk-standardized mortality rates and readmission rates were not associated for patients admitted with an acute myocardial infarction or pneumonia and were only weakly associated, within a certain range, for patients admitted with heart failure.
authors: Department of Internal Medicine/Section of Cardiovascular Medicine, Yale University School of Medicine, 1 Church St, Ste 200, New Haven, CT 06510, USA. harlan.krumholz@yale.edu
authors: Harlan M
authors: HM
authors: Krumholz
authors: Zhenqiu
authors: Z
authors: Lin
authors: Patricia S
authors: PS
authors: Keenan
authors: Jersey
authors: J
authors: Chen
authors: Joseph S
authors: JS
authors: Ross
authors: Elizabeth E
authors: EE
authors: Drye
authors: Susannah M
authors: SM
authors: Bernheim
authors: Yun
authors: Y
authors: Wang
authors: Elizabeth H
authors: EH
authors: Bradley
authors: Lein F
authors: LF
authors: Han
authors: Sharon-Lise T
authors: SL
authors: Normand
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000401:mortality* / Q000628:therapy; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment; D014481:United States
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