title: Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients With Acute Myocardial Infarction.
abstract: Little is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30-day mortality and unplanned readmission rates for Medicare fee-for-service patients hospitalized for acute myocardial infarction (AMI).
  
  
  
  Using 2009-2013 medical record-abstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixed-effects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospital-specific risk-standardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospital-specific 30-day all-cause risk-standardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the risk-standardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79-8.94) and 3.44% points (95% CI, 0.19-6.68) for the risk-standardized mortality and unplanned readmission rates, respectively.
  
  
  
  For Medicare fee-for-service patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30-day all-cause mortality and on unplanned readmissions.
authors.affiliation: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT yunwang@hsph.harvard.edu.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD.
authors.forename: Noel
authors.initials: N
authors.lastname: Eldridge
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Metersky
authors.affiliation: Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Rockville, MD.
authors.forename: Nancy
authors.initials: N
authors.lastname: Sonnenfeld
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Norwalk Hospital, Norwalk, CT.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Fine
authors.affiliation: Qualidigm, Wethersfield, CT.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Pandolfi
authors.affiliation: Qualidigm, Wethersfield, CT.
authors.forename: Sheila
authors.initials: S
authors.lastname: Eckenrode
authors.affiliation: Qualidigm, Wethersfield, CT.
authors.forename: Anila
authors.initials: A
authors.lastname: Bakullari
authors.affiliation: Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Deron H
authors.initials: DH
authors.lastname: Galusha
authors.affiliation: Department of Pharmacy, Griffin Hospital, Derby, CT.
authors.forename: Lisa
authors.initials: L
authors.lastname: Jaser
authors.affiliation: Qualidigm, Wethersfield, CT.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Verzier
authors.affiliation: Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Sudhakar V
authors.initials: SV
authors.lastname: Nuti
authors.affiliation: Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services, Rockville, MD.
authors.forename: David
authors.initials: D
authors.lastname: Hunt
authors.affiliation: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.affiliation: Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Department of Health Policy and Management, Yale School of Public Health, New Haven, CT Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D014487:Centers for Medicare and Medicaid Services, U.S.; D018588:Fee-for-Service Plans; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006780:Hospitals, Rural; D006788:Hospitals, Voluntary; D006801:Humans; D008297:Male; D006278:Medicare; D009026:Mortality; D009203:Myocardial Infarction / Q000628:therapy*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D061214:Patient Safety; D011379:Prognosis; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
keywords: Medicare; mortality; myocardial infarction; patient safety; readmission