title: Hospital strategy uptake and reductions in unplanned readmission rates for patients with heart failure: a prospective study.
abstract: BACKGROUND
  Despite recent reductions in national unplanned readmission rates, we have relatively little understanding of which hospital strategies are most associated with changes in risk-standardized readmission rates (RSRR).
  
  
  OBJECTIVE
  We examined associations between the change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies over 12-18 months in a national sample of hospitals.
  
  
  METHODS
  We conducted a prospective study of hospitals using a Web-based survey at baseline (November 2010-May 2011, n = 599, 91.0% response rate) and 12-18 months later (November 2011-October 2012, n = 501, 83.6% response rate), with RSRR measured at the same time points. The final analytic sample included 478 hospitals.
  
  
  METHODS
  The study included hospitals participating in the Hospital-to-Home (H2H) and State Action on Avoidable Rehospitalizations (STAAR) initiatives.
  
  
  METHODS
  We examined associations between change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies previously demonstrated to have increased between baseline and follow-up, using unadjusted and adjusted linear regression.
  
  
  RESULTS
  The average number of strategies taken up from baseline to follow-up was 1.6 (SE = 0.06); approximately one-quarter (25.3%) of hospitals took up at least three new strategies. Hospitals that adopted the strategy of routinely discharging patients with a follow-up appointment already scheduled experienced significant reductions in RSRR (reduction of 0.63 percentage point, p value < 0.05). Hospitals that took up three or more strategies had significantly greater reductions in RSRR compared to hospitals that took up only zero to two strategies (reduction of 1.29 versus 0.57 percentage point, p value < 0.05). Among the 117 hospitals that took up three or more strategies, 93 unique combinations of strategies were used.
  
  
  CONCLUSIONS
  Although most individual strategies were not associated with RSRR reduction, hospitals that took up any three or more strategies showed significantly greater reduction in RSRR compared to hospitals that took up fewer than three strategies.
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, 06520-8034, CT, USA, Elizabeth.bradley@yale.edu.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Heather
authors.initials: H
authors.lastname: Sipsma
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.forename: Chima D
authors.initials: CD
authors.lastname: Ndumele
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Brewster
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D058996:Quality Improvement; D018570:Risk Assessment; D012737:Sex Factors