title: Development of a clinical registry-based 30-day readmission measure for coronary artery bypass grafting surgery.
abstract: BACKGROUND
  Reducing readmissions is a major healthcare reform goal, and reimbursement penalties are imposed for higher-than-expected readmission rates. Most readmission risk models and performance measures are based on administrative rather than clinical data.
  
  
  RESULTS
  We examined rates and predictors of 30-day all-cause readmission following coronary artery bypass grafting surgery by using nationally representative clinical data (2008-2010) from the Society of Thoracic Surgeons National Database linked to Medicare claims records. Among 265 434 eligible Medicare records, 226 960 (86%) were successfully linked to Society of Thoracic Surgeons records; 162 572 (61%) isolated coronary artery bypass grafting admissions constituted the study cohort. Logistic regression was used to identify readmission risk factors; hierarchical regression models were then estimated. Risk-standardized readmission rates ranged from 12.6% to 23.6% (median, 16.8%) among 846 US hospitals with ≥30 eligible cases and ≥90% of eligible Centers for Medicare and Medicaid Services records linked to the Society of Thoracic Surgeons database. Readmission predictors (odds ratios [95% confidence interval]) included dialysis (2.02 [1.87-2.19]), severe chronic lung disease (1.58 [1.49-1.68]), creatinine (2.5 versus 1.0 or lower:1.49 [1.41-1.57]; 2.0 versus 1.0 or lower: 1.37 [1.32-1.43]), insulin-dependent diabetes mellitus (1.45 [1.39-1.51]), obesity in women (body surface area 2.2 versus 1.8: 1.44 [1.35-1.53]), female sex (1.38 [1.33-1.43]), immunosuppression (1.38 [1.28-1.49]), preoperative atrial fibrillation (1.36 [1.30-1.42]), age per 10-year increase (1.36 [1.33-1.39]), recent myocardial infarction (1.24 [1.08-1.42]), and low body surface area in men (1.22 [1.14-1.30]). C-statistic was 0.648. Fifty-two hospitals (6.1%) had readmission rates statistically better or worse than expected.
  
  
  CONCLUSIONS
  A coronary artery bypass grafting surgery readmission measure suitable for public reporting was developed by using the national Society of Thoracic Surgeons clinical data linked to Medicare readmission claims.
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.). dshahian@partners.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Xia
authors.initials: X
authors.lastname: He
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Suter
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Drye
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Shewan
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Lein
authors.initials: L
authors.lastname: Han
authors.affiliation: From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.); Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.); University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.); All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.); University of Florida College of Medicine, Jacksonville, FL (F.H.E.); Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.); Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.); Society of Thoracic Surgeons, Chicago, IL (C.M.S.); and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.).
authors.forename: Eric
authors.initials: E
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012042:Registries / Q000706:statistics & numerical data*; D020379:Risk Adjustment / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: coronary artery bypass; patient readmission; registries; risk adjustment