Impact of care coordination on 30-day readmission, mortality, and costs for heart failure.

Abstract

OBJECTIVES Although coordination of care has become the main focus of health care reform efforts to improve outcomes and decrease costs, limited information is available concerning the impact of care coordination on 30-day outcomes and costs. We used nationwide, population-based data to examine the influence of care coordination on 30-day readmission, mortality, and costs for heart failure (HF). STUDY DESIGN We analyzed 20,713 patients with HF 18 years or older discharged from hospitals in 2016 using Taiwan's National Health Insurance Research Database. The coordination of care among a patient's outpatient physicians was measured with care density. METHODS Multilevel regression models were used after adjustment for patient and hospital characteristics to explore the impact of care density on 30-day readmission, mortality, and costs. RESULTS Patients with high care coordination had lower odds of 30-day readmission (OR, 0.90; 95% CI, 0.82-0.98) and mortality (OR, 0.83; 95% CI, 0.70-0.99) and lower costs (cost ratio [CR], 0.84; 95% CI, 0.79-0.90) compared with those with low care coordination. Patients with medium care coordination had lower costs (CR, 0.92; 95% CI, 0.86-0.98) than those with low care coordination. CONCLUSIONS High care coordination is associated with decreased 30-day readmission, mortality, and costs for HF. Enhancing coordination of care has the potential to increase the value of care. It is important to monitor coordination of care and develop strategies to maintain high levels of care coordination for HF.