title: Reliability of Predicting Early Hospital Readmission After Discharge for an Acute Coronary Syndrome Using Claims-Based Data.
abstract: Early rehospitalization after discharge for an acute coronary syndrome, including acute myocardial infarction (AMI), is generally considered undesirable. The Centers for Medicare and Medicaid Services (CMS) base hospital financial incentives on risk-adjusted readmission rates after AMI, using claims data in its adjustment models. Little is known about the contribution to readmission risk of factors not captured by claims. For 804 consecutive patients >65 years discharged in 2011 to 2013 from 6 hospitals in Massachusetts and Georgia after an acute coronary syndrome, we compared a CMS-like readmission prediction model with an enhanced model incorporating additional clinical, psychosocial, and sociodemographic characteristics, after principal components analysis. Mean age was 73 years, 38% were women, 25% college educated, and 32% had a previous AMI; all-cause rehospitalization occurred within 30 days for 13%. In the enhanced model, previous coronary intervention (odds ratio [OR] = 2.05, 95% confidence interval [CI] 1.34 to 3.16; chronic kidney disease OR 1.89, 95% CI 1.15 to 3.10; low health literacy OR 1.75, 95% CI 1.14 to 2.69), lower serum sodium levels, and current nonsmoker status were positively associated with readmission. The discriminative ability of the enhanced versus the claims-based model was higher without evidence of overfitting. For example, for patients in the highest deciles of readmission likelihood, observed readmissions occurred in 24% for the claims-based model and 33% for the enhanced model. In conclusion, readmission may be influenced by measurable factors not in CMS' claims-based models and not controllable by hospitals. Incorporating additional factors into risk-adjusted readmission models may improve their accuracy and validity for use as indicators of hospital quality.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: mcmanusd@ummhc.org.
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Waring
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
authors.affiliation: Department of Community Medicine, Mercer University School of Medicine, Macon, Georgia.
authors.forename: David C
authors.initials: DC
authors.lastname: Parish
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Arlene
authors.initials: A
authors.lastname: Ash
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy*; D000368:Aged; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology