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National Survey of Hospital Strategies to Reduce Heart Failure Readmissions: Findings From the Get With the Guidelines-Heart Failure Registry
Study Questions:
What is the impact on 30-day readmission rates of hospital-level processes of care being used by self-selected hospitals participating in the American Heart Association’s Get With the Guidelines-Heart Failure (GWTG-HF) quality improvement initiative?
Methods:
This was a telephone survey administered to 100 randomly selected hospitals participating in the GWTG-HF quality improvement initiative. The primary measure of readmission was the hospital risk-standardized 30-day readmission rate for Medicare fee-for-service beneficiaries. The telephone survey captured care processes related to three domains: inpatient care, discharge and transitional care, and general quality improvement.
Results:
Of the 100 participating sites, 28% were academic centers and 64% were community hospitals. Six percent of respondents were physicians; the majority identified themselves as quality assurance or quality improvement managers (38%). The median readmission rate among participating sites (24.0%; 95% confidence interval [CI], 22.6%-25.7%) was comparable with the national average (24.6%; 95% CI, 23.5%-25.9%). There was substantial heterogeneity with respect to the processes of care used. Overall, neither inpatient care nor general quality improvement domains were associated with 30-day readmission rates. Hospitals in the lowest readmission rate quartile had modestly high discharge and transitional care domain scores (p = 0.03).
Conclusions:
In a telephone survey of randomly selected hospitals in the GWTG-HF registry, the authors demonstrated wide variation in hospital-delivered processes of care. While discharge and transitional care processes may be associated with some reduction in short-term readmission rates, no other care processes were reliably and consistently associated with reduced 30-day readmission rates.
Perspective:
By demonstrating no consistent associations between the varying hospital-level processes of care aimed at reducing short-term heart failure readmissions, the authors make a compelling argument to more clearly establish which interventions are actually effective. There should be an evidence base from which to create best practices and from which to reduce the proportion of heart failure readmissions that are preventable. It would be prudent to have created an evidence base from which to tackle preventable heart failure readmissions and create proven hospital-level care processes before penalizing hospitals for early readmissions.
Keywords: Heart Diseases, Patient Readmission, Cardiology, Heart Failure, United States
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