Association Between the Hospital Readmissions Reduction Program and Heart Failure Subtype Readmissions and Mortality in the USA

Wasiq Sheikh, Malik Bilal Ahmed, A. Parulkar, Tamara Lhungay, Esseim Sharma, Kevin W Kennedy, Zara Ahmed, Fabio V. Lima, H. Aronow, Antony Chu
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Abstract

Background: The Hospital Readmission Reduction Program (HRRP) sought to reduce readmissions by penalising centres with readmissions above the national average, and heart failure (HF) is the leading driver of the readmission penalty. Recent Medicare analyses question the effectiveness of this strategy. This study evaluated the efficacy of HRRP by utilising large national datasets and is the first to analyse based on heart failure subtypes. Methods: Aggregate data was used from the National Inpatient Sample (NIS) to study mortality and the National Readmissions Database (NRD) to study readmissions. Both included all payer-types and were stratified by heart failure subtype and time (pre- and post-HRRP implementation). Results: Patients with HF with preserved ejection fraction (HFpEF) tended to be older females with a higher proportion of comorbidities compared to patients with HF with reduced ejection fraction (HFrEF). In the post-HRRP period, readmission rates decreased for HFrEF (21.4% versus 22.3%, p<0.001) and HFpEF (21.2% versus 22.4%, p<0.001); readmission rates for the two subtypes were not statistically different compared to the other. Post-HRRP, inpatient mortality was consistent for HFrEF (2.8% versus 2.8%, p=0.087), but decreased for HFpEF (2.4% versus 2.5%, p=0.029). There were no significant differences noted in average length of stay. Patients with HFrEF were more frequently discharged to short-term hospitals or home with home healthcare, and patients with HFpEF were discharged to skilled nursing facilities more often. Estimated inpatient costs decreased in both subtypes post-HRRP, but readmission costs were higher for HFrEF. Conclusions: This study suggests that HRRP was associated with minimal change in readmission and inpatient mortality.
美国医院再入院减少计划与心力衰竭亚型再入院和死亡率之间的关系
背景:医院再入院减少计划(HRRP)试图通过惩罚再入院率高于全国平均水平的中心来减少再入院,而心力衰竭(HF)是再入院处罚的主要原因。最近的医疗保险分析对这一策略的有效性提出了质疑。本研究通过利用大型国家数据集评估HRRP的疗效,并且是第一个基于心力衰竭亚型进行分析的研究。方法:使用国家住院患者样本(NIS)的汇总数据来研究死亡率,并使用国家再入院数据库(NRD)来研究再入院率。两者均包括所有付款人类型,并按心力衰竭亚型和时间(hrrp实施前和实施后)进行分层。结果:与低射血分数(HFrEF)的HF患者相比,保留射血分数(HFpEF)的HF患者往往是老年女性,其合并症的比例更高。在hrrp后,HFrEF(21.4%对22.3%,p<0.001)和HFpEF(21.2%对22.4%,p<0.001)的再入院率下降;两种亚型的再入院率与其他亚型相比无统计学差异。hrrp后,HFrEF的住院死亡率一致(2.8%对2.8%,p=0.087),但HFpEF的住院死亡率下降(2.4%对2.5%,p=0.029)。在平均住院时间方面没有显著差异。HFpEF患者更频繁地出院到短期医院或家庭保健,HFpEF患者更频繁地出院到熟练的护理机构。hrrp后两种亚型的估计住院费用均下降,但HFrEF的再入院费用较高。结论:本研究表明HRRP与再入院率和住院死亡率的微小变化相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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