title: Association of 30-Day Readmission Metric for Heart Failure Under the Hospital Readmissions Reduction Program With Quality of Care and Outcomes.
abstract: This study sought to determine whether processes of care and long-term clinical outcomes for heart failure (HF) admissions across Get With The Guidelines-Heart Failure (GWTG-HF) program participating centers differ according to HF-specific risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]) as determined by the Hospital Readmission Reduction Program (HRRP).
  
  
  
  HRRP penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (ERR >1) for common conditions including HF. However, it is unclear whether the differences in this metric of hospital performance used by HRRP and related penalties are associated with measured quality of care and long-term outcomes.
  
  
  
  We analyzed data from the GWTG-HF registry linked to Medicare claims from July 2008 to June 2011. Using publically available data on HF-ERR in 2013, we stratified the participating centers into groups with low (HF-ERR ≤1) versus high (HF-ERR >1) risk-adjusted readmission rates. We compared the care quality, in-hospital, and 1-year clinical outcomes across the 2 groups in unadjusted and multivariable adjusted analysis.
  
  
  
  The analysis included 171 centers with 43,143 participants; 49% of centers had high risk-adjusted 30-day readmission rates (HF-ERR >1). There were no differences between the low and high risk-adjusted 30-day readmission groups in median adherence rate to all performance measures (95.7% vs. 96.5%; p = 0.37) or median percentage of defect-free care (90.0% vs. 91.1%; p = 0.47). The composite 1-year outcome of death or all-cause readmission rates was also not different between the 2 groups (median 62.9% vs. 65.3%; p = 0.10). The high HF-ERR group had higher 1-year all-cause readmission rates (median 59.1% vs. 54.7%; p = 0.01). However, the 1-year mortality rates were lower among high versus low HF-ERR group with a trend toward statistical significance (median 28.2% vs. 31.7%; p = 0.07).
  
  
  
  Quality of care and clinical outcomes were comparable among hospitals with high versus low risk-adjusted 30-day HF readmission rates. These findings raise questions about the validity of the HRRP performance metric in identifying and penalizing low-performance centers.
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ambarish
authors.initials: A
authors.lastname: Pandey
authors.affiliation: Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Harsh
authors.initials: H
authors.lastname: Golwala
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Haolin
authors.initials: H
authors.lastname: Xu
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Roland
authors.initials: R
authors.lastname: Matsouaka
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Pencina
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Division of Cardiology, Stanford University, Palo Alto, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Division of Cardiology, Northwestern University, Chicago, Illinois.
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: Ronald Reagan-UCLA Medical Center, Los Angeles, California. Electronic address: gfonarow@mednet.ucla.edu.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care; D011787:Quality of Health Care; D012042:Registries
keywords: heart failure; mortality; quality of care; readmission