title: Hospital strategies associated with 30-day readmission rates for patients with heart failure.
abstract: BACKGROUND
  Reducing hospital readmission rates is a national priority; however, evidence about hospital strategies that are associated with lower readmission rates is limited. We sought to identify hospital strategies that were associated with lower readmission rates for patients with heart failure.
  
  
  RESULTS
  Using data from a Web-based survey of hospitals participating in national quality initiatives to reduce readmission (n=599; 91% response rate) during 2010-2011, we constructed a multivariable linear regression model, weighted by hospital volume, to determine strategies independently associated with risk-standardized 30-day readmission rates (RSRRs) adjusted for hospital teaching status, geographic location, and number of staffed beds. Strategies that were associated with lower hospital RSRRs included the following: (1) partnering with community physicians or physician groups to reduce readmission (0.33% percentage point lower RSRRs; P=0.017), (2) partnering with local hospitals to reduce readmissions (0.34 percentage point; P=0.020), (3) having nurses responsible for medication reconciliation (0.18 percentage point; P=0.002), (4) arranging follow-up appointments before discharge (0.19 percentage point; P=0.037), (5) having a process in place to send all discharge paper or electronic summaries directly to the patient's primary physician (0.21 percentage point; P=0.004), and (6) assigning staff to follow up on test results that return after the patient is discharged (0.26 percentage point; P=0.049). Although statistically significant, the magnitude of the effects was modest with individual strategies associated with less than half a percentage point reduction in RSRRs; however, hospitals that implemented more strategies had significantly lower RSRRs (reduction of 0.34 percentage point for each additional strategy).
  
  
  CONCLUSIONS
  Several strategies were associated with lower hospital RSRRs for patients with heart failure.
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06520, USA. Elizabeth.bradley@yale.edu
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Leslie
authors.initials: L
authors.lastname: Curry
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.forename: Heather
authors.initials: H
authors.lastname: Sipsma
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Mary Norine
authors.initials: MN
authors.lastname: Walsh
authors.forename: Don
authors.initials: D
authors.lastname: Goldmann
authors.forename: Neal
authors.initials: N
authors.lastname: White
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000592:standards*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000592:standards*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States
keywords: heart failure; patient readmission; quality improvement