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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
BACKGROUND: 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 rea...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079017/ https://www.ncbi.nlm.nih.gov/pubmed/27628574 http://dx.doi.org/10.1161/JAHA.116.003503 |
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author | Hegeman, Timothy W. Glorioso, Thomas J. Hess, Edward Barón, Anna E. Ho, P. Michael Maddox, Thomas M. Bradley, Steven M. Burke, Robert E. |
author_facet | Hegeman, Timothy W. Glorioso, Thomas J. Hess, Edward Barón, Anna E. Ho, P. Michael Maddox, Thomas M. Bradley, Steven M. Burke, Robert E. |
author_sort | Hegeman, Timothy W. |
collection | PubMed |
description | BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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. |
format | Online Article Text |
id | pubmed-5079017 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-50790172016-10-28 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 Hegeman, Timothy W. Glorioso, Thomas J. Hess, Edward Barón, Anna E. Ho, P. Michael Maddox, Thomas M. Bradley, Steven M. Burke, Robert E. J Am Heart Assoc Original Research BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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. John Wiley and Sons Inc. 2016-09-14 /pmc/articles/PMC5079017/ /pubmed/27628574 http://dx.doi.org/10.1161/JAHA.116.003503 Text en © 2016 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/4.0/) 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 Hegeman, Timothy W. Glorioso, Thomas J. Hess, Edward Barón, Anna E. Ho, P. Michael Maddox, Thomas M. Bradley, Steven M. Burke, Robert E. 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 |
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 |
title_full | 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 |
title_fullStr | 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 |
title_full_unstemmed | 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 |
title_short | 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 |
title_sort | 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 |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079017/ https://www.ncbi.nlm.nih.gov/pubmed/27628574 http://dx.doi.org/10.1161/JAHA.116.003503 |
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