National patterns of risk-standardized mortality and readmission after hospitalization for acute myocardial infarction, heart failure, and pneumonia: update on publicly reported outcomes measures based on the 2013 release.
BACKGROUND
The Centers for Medicare & Medicaid Services publicly reports risk-standardized mortality rates (RSMRs) within 30-days of admission and, in 2013, risk-standardized unplanned readmission rates (RSRRs) within 30-days of discharge for patients hospitalized with acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Current publicly reported data do not focus on variation in national results or annual changes.


OBJECTIVE
Describe U.S. hospital performance on AMI, HF, and pneumonia mortality and updated readmission measures to provide perspective on national performance variation.


METHODS
To identify recent changes and variation in national hospital-level mortality and readmission for AMI, HF, and pneumonia, we performed cross-sectional panel analyses of national hospital performance on publicly reported measures.


METHODS
Fee-for-service Medicare and Veterans Health Administration beneficiaries, 65 years or older, hospitalized with principal discharge diagnoses of AMI, HF, or pneumonia between July 2009 and June 2012. RSMRs/RSRRs were calculated using hierarchical logistic models risk-adjusted for age, sex, comorbidities, and patients' clustering among hospitals.


RESULTS
Median (range) RSMRs for AMI, HF, and pneumonia were 15.1% (9.4-21.0%), 11.3% (6.4-17.9%), and 11.4% (6.5-24.5%), respectively. Median (range) RSRRs for AMI, HF, and pneumonia were 18.2% (14.4-24.3%), 22.9% (17.1-30.7%), and 17.5% (13.6-24.0%), respectively. Median RSMRs declined for AMI (15.5% in 2009-2010, 15.4% in 2010-2011, 14.7% in 2011-2012) and remained similar for HF (11.5% in 2009-2010, 11.9% in 2010-2011, 11.7% in 2011-2012) and pneumonia (11.8% in 2009-2010, 11.9% in 2010-2011, 11.6% in 2011-2012). Median hospital-level RSRRs declined: AMI (18.5% in 2009-2010, 18.5% in 2010-2011, 17.7% in 2011-2012), HF (23.3% in 2009-2010, 23.1% in 2010-2011, 22.5% in 2011-2012), and pneumonia (17.7% in 2009-2010, 17.6% in 2010-2011, 17.3% in 2011-2012).


CONCLUSIONS
We report the first national unplanned readmission results demonstrating declining rates for all three conditions between 2009-2012. Simultaneously, AMI mortality continued to decline, pneumonia mortality was stable, and HF mortality experienced a small increase.
Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation, 1 Church Street, Suite 200, New Haven, CT, 06510, USA, Lisa.suter@yale.edu.
Lisa G
LG
Suter
Shu-Xia
SX
Li
Jacqueline N
JN
Grady
Zhenqiu
Z
Lin
Yongfei
Y
Wang
Kanchana R
KR
Bhat
Dima
D
Turkmani
Steven B
SB
Spivack
Peter K
PK
Lindenauer
Angela R
AR
Merrill
Elizabeth E
EE
Drye
Harlan M
HM
Krumholz
Susannah M
SM
Bernheim
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000639:trends*; D010359:Patient Readmission / Q000639:trends*; D011014:Pneumonia / Q000401:mortality* / Q000628:therapy; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology