Claudia Fischer1, Ewout W Steyerberg2, Gregg C Fonarow3, Theodore G Ganiats4, Hester F Lingsma5. 1. Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands. Electronic address: c.fischer@erasmusmc.nl. 2. Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands. Electronic address: e.steyerberg@erasmusmc.nl. 3. Ahmanson-UCLA Cardiomyopathy Center, UCLA Division of Cardiology, Los Angeles, CA. Electronic address: gfonarow@mednet.ucla.edu. 4. Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA. Electronic address: tganiats@ucsd.edu. 5. Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands. Electronic address: h.lingsma@erasmusmc.nl.
Abstract
UNLABELLED: In recent years, readmission rates have been increasingly used as a measure of quality of hospital care for patients with heart failure. The aim of this systematic review is to assess the scientific evidence regarding the relation between hospital readmission rates and quality of hospital care for patients with heart failure. METHODS: We defined quality of hospital care for patients with heart failure by adhering to the performance measures developed by the American College of Cardiology (ACC)/American Heart Association (AHA). Relevant articles published in English and indexed in the bibliographic databases Embase, Medline OvidSP, Web of Science, Cochrane Central, and PubMed were reviewed. RESULTS: Of the 2,638 studies identified, 18 were included. They varied widely in their methodology, data sources used, and study populations. We found mixed but rather limited evidence that there is a relationship between the ACC/AHA process measures and the rate of readmission. Four of 10 studies showed a significant correlation of readmission rate with "angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use." Three of 9 studies showed a significant correlation between readmission rates and "evaluation of left ventricular systolic function." One of 7 studies showed a significant correlation with "smoking cessation counseling," and 2 of 8 showed a significant correlation with "providing discharge instructions." No evidence was found for a relationship between readmission rates and the performance measure "warfarin for atrial fibrillation." CONCLUSIONS: Readmission rates after heart failure are mostly not related to the evidence-based ACC/AHA in-hospital process indicators for heart failure. It is unclear whether in-hospital quality of care is the key determinate of the readmission rate or whether readmissions are likely influenced more by postdischarge care. Further research is needed to clarify whether the readmission rate is a reflection of hospital care or quality of care on a larger level, especially when it is used for a pay-for-performance scheme to measure quality of hospital care.
UNLABELLED: In recent years, readmission rates have been increasingly used as a measure of quality of hospital care for patients with heart failure. The aim of this systematic review is to assess the scientific evidence regarding the relation between hospital readmission rates and quality of hospital care for patients with heart failure. METHODS: We defined quality of hospital care for patients with heart failure by adhering to the performance measures developed by the American College of Cardiology (ACC)/American Heart Association (AHA). Relevant articles published in English and indexed in the bibliographic databases Embase, Medline OvidSP, Web of Science, Cochrane Central, and PubMed were reviewed. RESULTS: Of the 2,638 studies identified, 18 were included. They varied widely in their methodology, data sources used, and study populations. We found mixed but rather limited evidence that there is a relationship between the ACC/AHA process measures and the rate of readmission. Four of 10 studies showed a significant correlation of readmission rate with "angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use." Three of 9 studies showed a significant correlation between readmission rates and "evaluation of left ventricular systolic function." One of 7 studies showed a significant correlation with "smoking cessation counseling," and 2 of 8 showed a significant correlation with "providing discharge instructions." No evidence was found for a relationship between readmission rates and the performance measure "warfarin for atrial fibrillation." CONCLUSIONS: Readmission rates after heart failure are mostly not related to the evidence-based ACC/AHA in-hospital process indicators for heart failure. It is unclear whether in-hospital quality of care is the key determinate of the readmission rate or whether readmissions are likely influenced more by postdischarge care. Further research is needed to clarify whether the readmission rate is a reflection of hospital care or quality of care on a larger level, especially when it is used for a pay-for-performance scheme to measure quality of hospital care.
Authors: Ambarish Pandey; Harsh Golwala; Hurst M Hall; Tracy Y Wang; Di Lu; Ying Xian; Karen Chiswell; Karen E Joynt; Abhinav Goyal; Sandeep R Das; Dharam Kumbhani; Howard Julien; Gregg C Fonarow; James A de Lemos Journal: JAMA Cardiol Date: 2017-07-01 Impact factor: 14.676
Authors: Hester F Lingsma; Alex Bottle; Steve Middleton; Job Kievit; Ewout W Steyerberg; Perla J Marang-van de Mheen Journal: BMC Health Serv Res Date: 2018-02-14 Impact factor: 2.655
Authors: Vera Maria Avaldi; Jacopo Lenzi; Stefano Urbinati; Dario Molinazzi; Carlo Descovich; Anselmo Campagna; Martina Taglioni; Angelo Fioritti; Maria Pia Fantini Journal: BMJ Open Date: 2017-11-03 Impact factor: 2.692