Differences in regional hospital readmission rates for heart failure are more closely tied to the availability of care and socioeconomics than to hospital performance or patients' degree of illness, according to research presented at the American Heart Association's Quality of Care & Outcomes Research Scientific Sessions 2012.
Researchers analyzed national billing records of more than 3,000 hospitals in 2008-09 for more than 1 million elderly Medicare patients with heart failure. Of the patients in the review, 55 percent were female, 11 percent were black and they had an average age of 81.
They found regional readmission rates for heart failure vary widely from 10 percent to 32 percent. Communities with higher readmission rates were likely to have more physicians and hospital beds and their populations were likely to be poor, black and relatively sicker. People 65 and older are also readmitted more frequently. Other key findings include:
• Supply-side factors including availability of doctors and hospitals beds were the strongest predictors of differences in readmission rates, accounting for 17 percent.
• Poverty and minority racial makeup was linked to 9 percent of the variation in readmission rates.
• Hospital-performance quality accounted for 5 percent and patients' degree of illness 4 percent.
"To really address the readmissions issue, we need to think about this in terms of community and population health," a study author said. "Focusing on community-level factors such as the supply and mix of physicians and targeting efforts towards poor and minority communities may be more fruitful approaches to reducing readmissions. We need to think outside the walls of the hospital."
The researchers acknowledged their study did not include all potential influences, such as other illnesses.
Researchers analyzed national billing records of more than 3,000 hospitals in 2008-09 for more than 1 million elderly Medicare patients with heart failure. Of the patients in the review, 55 percent were female, 11 percent were black and they had an average age of 81.
They found regional readmission rates for heart failure vary widely from 10 percent to 32 percent. Communities with higher readmission rates were likely to have more physicians and hospital beds and their populations were likely to be poor, black and relatively sicker. People 65 and older are also readmitted more frequently. Other key findings include:
• Supply-side factors including availability of doctors and hospitals beds were the strongest predictors of differences in readmission rates, accounting for 17 percent.
• Poverty and minority racial makeup was linked to 9 percent of the variation in readmission rates.
• Hospital-performance quality accounted for 5 percent and patients' degree of illness 4 percent.
"To really address the readmissions issue, we need to think about this in terms of community and population health," a study author said. "Focusing on community-level factors such as the supply and mix of physicians and targeting efforts towards poor and minority communities may be more fruitful approaches to reducing readmissions. We need to think outside the walls of the hospital."
The researchers acknowledged their study did not include all potential influences, such as other illnesses.
Related Articles on Readmissions:
UC Davis CMO Dr. Allan Siefkin: Creating a Culture of Safety, Quality
Expensive Hospital Readmission Linked to Healthcare-Associated Infections
NQF Endorses All-Cause Unplanned Readmissions Measures