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. 2013 Jul;6(4):444-50.
doi: 10.1161/CIRCOUTCOMES.111.000101.

Hospital strategies associated with 30-day readmission rates for patients with heart failure

Elizabeth H Bradley  1 , Leslie Curry, Leora I Horwitz, Heather Sipsma, Yongfei Wang, Mary Norine Walsh, Don Goldmann, Neal White, Ileana L Piña, Harlan M Krumholz
Affiliations

Hospital strategies associated with 30-day readmission rates for patients with heart failure

Elizabeth H Bradley et al. Circ Cardiovasc Qual Outcomes. 2013 Jul.

Abstract

Background: Reducing hospital readmission rates is a national priority; however, evidence about hospital strategies that are associated with lower readmission rates is limited. We sought to identify hospital strategies that were associated with lower readmission rates for patients with heart failure.

Methods and results: Using data from a Web-based survey of hospitals participating in national quality initiatives to reduce readmission (n=599; 91% response rate) during 2010-2011, we constructed a multivariable linear regression model, weighted by hospital volume, to determine strategies independently associated with risk-standardized 30-day readmission rates (RSRRs) adjusted for hospital teaching status, geographic location, and number of staffed beds. Strategies that were associated with lower hospital RSRRs included the following: (1) partnering with community physicians or physician groups to reduce readmission (0.33% percentage point lower RSRRs; P=0.017), (2) partnering with local hospitals to reduce readmissions (0.34 percentage point; P=0.020), (3) having nurses responsible for medication reconciliation (0.18 percentage point; P=0.002), (4) arranging follow-up appointments before discharge (0.19 percentage point; P=0.037), (5) having a process in place to send all discharge paper or electronic summaries directly to the patient's primary physician (0.21 percentage point; P=0.004), and (6) assigning staff to follow up on test results that return after the patient is discharged (0.26 percentage point; P=0.049). Although statistically significant, the magnitude of the effects was modest with individual strategies associated with less than half a percentage point reduction in RSRRs; however, hospitals that implemented more strategies had significantly lower RSRRs (reduction of 0.34 percentage point for each additional strategy).

Conclusions: Several strategies were associated with lower hospital RSRRs for patients with heart failure.

Keywords: heart failure; patient readmission; quality improvement.

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Figures

Figure 1
Figure 1. Number of selected strategies implemented and RSRR
Note: B = - 0.34, SE = 0.04, P < 0.001 in multivariable model adjusting for teaching status, region, and number of hospital beds Number of selected strategies (possible range 0–10) was calculated by assigning a 1 to every strategy implemented that was positively associated with RSRR and by assigning a 1 to every strategy not implemented that was negatively associated with RSRR. Adjusted R-Square = 0.14
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