title: Relation between process measures and diagnosis-specific readmission rates in patients with heart failure.
abstract: OBJECTIVE
  To explore the relations between cause-specific readmission rates and National Heart Failure Audit process of care measures in patients admitted for heart failure (HF).
  
  
  METHODS
  Using admissions data for all acute hospitals in England for April 2009-March 2012, we defined an index admission as the first emergency admission with a primary diagnosis of HF for at least three years. We compared risk-adjusted readmission rates for HF and for all non-HF diagnoses combined, risk-adjusted in-hospital mortality rates and performance on six Audit process measures.
  
  
  RESULTS
  14.7% of 123,644 patients died during the index admission. Of 105,441 index live discharges, 6853 (6.5%) were readmitted as emergencies within 7 days and 20,144 (19.1%) within 30 days. Index admission mortality rates correlated positively but weakly with non-HF readmission rates but not at all with HF rates. There was modest positive correlation at 7 days between HF and non-HF readmission rates (r=+0.24) but no significant relation at 30 or 365 days. All six process measures (prescribing of ACE inhibitors and beta-blockers, echocardiogram, cardiology inpatient and follow-up by cardiologist and HF liaison) correlated modestly but significantly with lower HF readmission rates at 7 days (r at most -0.26), only three did at 30 days and only cardiology follow-up did for non-HF at either 7 or 30 days; all associations were diminished at 365 days.
  
  
  CONCLUSIONS
  Hospitals scoring higher on evidence-based HF process measures had lower readmission rates, though the association seems limited to HF readmissions and is modest in strength and duration.
authors.affiliation: Dr Foster Unit, Imperial College, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.affiliation: Dr Foster Unit, Imperial College, London, UK.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Goudie
authors.affiliation: National Heart and Lung Institute, Imperial College London (Royal Brompton Hospital), London, UK.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
authors.affiliation: Chelsea and Westminster Hospital, Imperial College London, London, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Bell
authors.affiliation: Dr Foster Unit, Imperial College, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004452:Echocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008501:Medical Records, Problem-Oriented; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors