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Characterizing Types of Readmission After Acute Coronary Syndrome Hospitalization: Implications for Quality Reporting
BACKGROUND: Thirty‐day readmission rates have been tied to hospital reimbursement in the United States, but remain controversial as measures of healthcare quality. We profile the timing, main diagnoses, and survival outcomes of inpatient and emergency department readmissions after acute coronary syn...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Blackwell Publishing Ltd
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4323836/ https://www.ncbi.nlm.nih.gov/pubmed/25237046 http://dx.doi.org/10.1161/JAHA.114.001046 |
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author | Southern, Danielle A. Ngo, Jennifer Martin, Billie‐Jean Galbraith, P. Diane Knudtson, Merril L. Ghali, William A. James, Matthew T. Wilton, Stephen B. |
author_facet | Southern, Danielle A. Ngo, Jennifer Martin, Billie‐Jean Galbraith, P. Diane Knudtson, Merril L. Ghali, William A. James, Matthew T. Wilton, Stephen B. |
author_sort | Southern, Danielle A. |
collection | PubMed |
description | BACKGROUND: Thirty‐day readmission rates have been tied to hospital reimbursement in the United States, but remain controversial as measures of healthcare quality. We profile the timing, main diagnoses, and survival outcomes of inpatient and emergency department readmissions after acute coronary syndrome (ACS), based on a large regional database. METHODS AND RESULTS: Patients enrolled in the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry with an ACS hospitalization between April 2008 and March 2010 (n=3411) were included. Primary outcomes were inpatient and emergency department–only readmissions, at 30 days and 1 year. Predictors of 30‐day readmission were identified, and the association between 30‐day readmission status and mortality was evaluated. A total of 1170 (34.3%) patients had ≥1 hospital readmission within 30 days, reaching 2106 (61.7%) within 1 year of ACS discharge. Of first readmissions, 45% were emergency department only and 53% were for cardiovascular or possibly related diagnoses. Renal disease and diabetes predicted all‐cause readmissions at 30 days and 1 year, but there were no robust predictors of cardiovascular readmissions. Thirty‐day inpatient, but not emergency department, readmissions were associated with increased mortality. CONCLUSIONS: Hospital readmissions within 30 days after discharge for ACS are common, and associated with increased mortality. However, our findings underline that readmissions are quite heterogeneous in nature, and that many readmissions are unrelated to index stay and thus not easily predicted with common clinical variables. All‐cause 30‐day readmission rates may be too simplistic, and perhaps even misleading, as a hospital performance metric. |
format | Online Article Text |
id | pubmed-4323836 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Blackwell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-43238362015-02-23 Characterizing Types of Readmission After Acute Coronary Syndrome Hospitalization: Implications for Quality Reporting Southern, Danielle A. Ngo, Jennifer Martin, Billie‐Jean Galbraith, P. Diane Knudtson, Merril L. Ghali, William A. James, Matthew T. Wilton, Stephen B. J Am Heart Assoc Original Research BACKGROUND: Thirty‐day readmission rates have been tied to hospital reimbursement in the United States, but remain controversial as measures of healthcare quality. We profile the timing, main diagnoses, and survival outcomes of inpatient and emergency department readmissions after acute coronary syndrome (ACS), based on a large regional database. METHODS AND RESULTS: Patients enrolled in the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry with an ACS hospitalization between April 2008 and March 2010 (n=3411) were included. Primary outcomes were inpatient and emergency department–only readmissions, at 30 days and 1 year. Predictors of 30‐day readmission were identified, and the association between 30‐day readmission status and mortality was evaluated. A total of 1170 (34.3%) patients had ≥1 hospital readmission within 30 days, reaching 2106 (61.7%) within 1 year of ACS discharge. Of first readmissions, 45% were emergency department only and 53% were for cardiovascular or possibly related diagnoses. Renal disease and diabetes predicted all‐cause readmissions at 30 days and 1 year, but there were no robust predictors of cardiovascular readmissions. Thirty‐day inpatient, but not emergency department, readmissions were associated with increased mortality. CONCLUSIONS: Hospital readmissions within 30 days after discharge for ACS are common, and associated with increased mortality. However, our findings underline that readmissions are quite heterogeneous in nature, and that many readmissions are unrelated to index stay and thus not easily predicted with common clinical variables. All‐cause 30‐day readmission rates may be too simplistic, and perhaps even misleading, as a hospital performance metric. Blackwell Publishing Ltd 2014-09-18 /pmc/articles/PMC4323836/ /pubmed/25237046 http://dx.doi.org/10.1161/JAHA.114.001046 Text en © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/3.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Southern, Danielle A. Ngo, Jennifer Martin, Billie‐Jean Galbraith, P. Diane Knudtson, Merril L. Ghali, William A. James, Matthew T. Wilton, Stephen B. Characterizing Types of Readmission After Acute Coronary Syndrome Hospitalization: Implications for Quality Reporting |
title | Characterizing Types of Readmission After Acute Coronary Syndrome Hospitalization: Implications for Quality Reporting |
title_full | Characterizing Types of Readmission After Acute Coronary Syndrome Hospitalization: Implications for Quality Reporting |
title_fullStr | Characterizing Types of Readmission After Acute Coronary Syndrome Hospitalization: Implications for Quality Reporting |
title_full_unstemmed | Characterizing Types of Readmission After Acute Coronary Syndrome Hospitalization: Implications for Quality Reporting |
title_short | Characterizing Types of Readmission After Acute Coronary Syndrome Hospitalization: Implications for Quality Reporting |
title_sort | characterizing types of readmission after acute coronary syndrome hospitalization: implications for quality reporting |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4323836/ https://www.ncbi.nlm.nih.gov/pubmed/25237046 http://dx.doi.org/10.1161/JAHA.114.001046 |
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