title: Facility-Level Percutaneous Coronary Intervention Readmission Rates Are Not Associated With Facility-Level Mortality: Insights From the VA Clinical Assessment, Reporting, and Tracking (CART) Program.
abstract: Thirty-day readmission after percutaneous coronary intervention (PCI) is common, costly, and linked to poor patient outcomes. Accordingly, facility-level 30-day readmission rates have been considered as a potential quality measure. However, it is unknown whether facility-level 30-day readmission rates are associated with facility-level mortality. We sought to determine the effect of 30-day readmissions after PCI on mortality at both the patient and facility level in the Veterans Administration hospital system.
  
  
  
  We included all patients who underwent PCI in the Veterans Administration hospital system nationally from October 2007 through August 2012, comparing all-cause mortality rates between patients with and without 30-day readmissions following PCI. Patients were then aggregated at the hospital level to evaluate the correlation between hospital-level readmission rates with hospital-level 1-year mortality rates. Among 41 069 patients undergoing PCI at 62 sites, 12.2% were readmitted within 30 days of discharge. Patients with 30-day readmission had higher risk-adjusted mortality (hazard ratio 1.53, 95% CI 1.44-1.63, P<0.0001). Facilities varied widely in 30-day readmission rates (systemwide range of 6.6-19.4%, median 11.8%, interquartile range 10.0-13.2%); however, adjusted facility-level readmission rates were not correlated with adjusted 1-year mortality rates.
  
  
  
  Thirty-day readmissions after PCI are common and are a significant risk factor for mortality for individual patients even after robust statistical adjustment for clinical confounding. However, lack of correlation between readmission and mortality at the facility level suggests that quality improvement based on facility-level readmission rates will not modify mortality in this high-risk group.
authors.affiliation: University of Colorado School of Medicine, Aurora, CO Colorado Cardiovascular Outcomes Research Consortium, Denver, CO timothy.hegeman@vanderbilt.edu.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Hegeman
authors.affiliation: Colorado Cardiovascular Outcomes Research Consortium, Denver, CO VA Eastern Colorado Health Care System, Denver, CO Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Glorioso
authors.affiliation: Colorado Cardiovascular Outcomes Research Consortium, Denver, CO VA Eastern Colorado Health Care System, Denver, CO Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Edward
authors.initials: E
authors.lastname: Hess
authors.affiliation: University of Colorado School of Medicine, Aurora, CO Colorado Cardiovascular Outcomes Research Consortium, Denver, CO VA Eastern Colorado Health Care System, Denver, CO Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Barón
authors.affiliation: University of Colorado School of Medicine, Aurora, CO Colorado Cardiovascular Outcomes Research Consortium, Denver, CO VA Eastern Colorado Health Care System, Denver, CO.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: University of Colorado School of Medicine, Aurora, CO Colorado Cardiovascular Outcomes Research Consortium, Denver, CO VA Eastern Colorado Health Care System, Denver, CO.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: University of Colorado School of Medicine, Aurora, CO Colorado Cardiovascular Outcomes Research Consortium, Denver, CO VA Eastern Colorado Health Care System, Denver, CO.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bradley
authors.affiliation: University of Colorado School of Medicine, Aurora, CO VA Eastern Colorado Health Care System, Denver, CO.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Burke
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: cardiac catheterization; cardiovascular outcomes; coronary artery disease; mortality; readmission