title: Clinical preventability of 30-day readmission after percutaneous coronary intervention.
abstract: BACKGROUND
  Early readmission after PCI is an important contributor to healthcare expenditures and a target for performance measurement. The extent to which 30-day readmissions after PCI are preventable is unknown yet essential to minimizing their occurrence.
  
  
  RESULTS
  PCI patients readmitted to hospital at which PCI was performed within 30 days of discharge at the Massachusetts General Hospital and Brigham and Women's Hospital were identified, and their medical records were independently reviewed by 2 physicians. Each reviewer used an ordinal scale (0, not; 1, possibly; 2, probably; and 3, definitely preventable) to rate clinical preventability, and a total sum score ≥2 was considered preventable. Characteristics of preventable and unpreventable readmissions were compared, and predictors of clinical preventability were assessed by using multivariate logistic regression. Of 9288 PCIs performed, 9081 (97.8%) patients survived to initial hospital discharge and 1007 (11.1%) were readmitted to the index hospital within 30 days. After excluding repeat readmissions, 893 readmissions were reviewed. Fair agreement between physician reviewers was observed (weighted κ statistic 0.44 [95% CI 0.39 to 0.49]). After aggregation of scores, 380 (42.6%) readmissions were deemed preventable and 513 (57.4%) were deemed not preventable. Common causes of preventable readmissions included staged PCI without new symptoms (14.7%), vascular/bleeding complications of PCI (10.0%), and congestive heart failure (9.7%).
  
  
  CONCLUSIONS
  Nearly half of 30-day readmissions after PCI may have been prevented by changes in clinical decision-making. Focusing on these readmissions may reduce readmission rates.
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W., S.W.W., C.B., R.W.Y.).
authors.forename: Jason H
authors.initials: JH
authors.lastname: Wasfy
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.B.S., L.M.).
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Strom
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W., S.W.W., C.B., R.W.Y.).
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Waldo
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W., S.W.W., C.B., R.W.Y.).
authors.forename: Cashel
authors.initials: C
authors.lastname: O'Brien
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.J.W.).
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Wimmer
authors.affiliation: Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.H.Z., J.L.).
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Zai
authors.affiliation: Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.H.Z., J.L.).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Luttrell
authors.affiliation: Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (J.A.S., K.F.K.).
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (J.A.S., K.F.K.).
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kennedy
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA (S.L.T.N.) Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.L.T.N.).
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.B.S., L.M.) Harvard Clinical Research Institute, Boston, MA (L.M., R.W.Y.).
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W., S.W.W., C.B., R.W.Y.) Harvard Clinical Research Institute, Boston, MA (L.M., R.W.Y.).
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy*; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D015588:Observer Variation; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D011322:Primary Prevention / Q000379:methods*; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D014481:United States
keywords: Outcomes Research; Percutaneous Coronary Intervention; Performance Metrics; Quality Improvement; Readmission