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Readmission rates for patients with HF similar in U.S., Canada
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Temporal declines in 30-day all-cause readmissions were similar in Canada and the United States among patients with HF, according to a study published in JAMA Cardiology.
“Our finding that all-cause readmission rates in the United States have declined to the same extent over the past decade as those in Canada would suggest that the implementation of financial payment penalties in October 2012 under the [Hospital Readmissions Reduction Program] may not have had as large an influence as was previously thought,” Marc D. Samsky, MD, cardiology fellow at Duke University School of Medicine, and colleagues wrote.
Canadian, American patients
Researchers analyzed data from 239,031 patients from Canada (mean age, 77 years; 50% men) and 2,781,829 patients from the United States (mean age, 78 years; 45% men) who were discharged after HF hospitalization between April 2005 and December 2015. The Hospital Readmissions Reduction Program (HRRP) was implemented by CMS in October 2012.
Outcomes of interest included 30-day all-cause readmission rates, index hospitalization length of stay and 30-day HF-specific readmission rates. Other outcomes of interest included total inpatient days of care 30 days after admission and 30-day non-CV readmission rates.
The mean length of stay in Canadian hospitals declined from 7.5 days in 2005 to 7.3 days in 2015 (P < .001). This remained stable in the United States during the time period (4.9 days; P < .001).
From 2005 to 2015, Canadian hospitals also had declines in 30-day readmission rates (19.7% to 17.6%; P < .001) and HF-specific readmission rates at 30 days (8.4% to 6.9%; P < .001). Similar declines occurred in the United States for all-cause readmissions (21.2% to 18.5%; P < .001) and HF-specific readmissions (7.6% to 5.7%; P < .001).
Although small, there were statistically significant positive correlations between length of stay and readmissions at 30 days in both the United States (OR = 1.01; 95% CI, 1.01-1.01) and Canada (OR = 1.01; 95% CI, 1.01-1.01).
Readmission rates
All-cause readmission rates did not significantly differ in either country before and after October 2012 based on an interrupted time-series analysis that compared readmission rates before and after the HRRP was implemented.
All-cause readmissions in Canada decreased 1.1% per year before the program was implemented and 1.3% after implementation (P for slope change = .84), whereas the United States decreased 1.6% per year before and 1.8% per year after the program was implemented in October 2012 (P for slope change = .6).
“Further efforts beyond public reporting and financial penalties are required to achieve better outcomes for patients with HF who are discharged from the hospital,” Samsky and colleagues wrote.
“Are we sure that the HRRP has failed to improve patient care or led to patient harm? Of course not, but the evidence is strong enough to suggest that this well-intentioned policy may not be as helpful to patients as intended,” Ashish K. Jha, MD, MPH, dean for global strategy, K.T. Li Professor of Global Health and director of the Harvard Global Health Institute at Harvard T.H. Chan School of Public Health, wrote in a related editorial. “The sign of a mature, sophisticated health care system is that it is able to make changes when new data become available. In that light, it is time to create incentives that truly promote integrated, higher-quality care, without harming patients along the way.” – by Darlene Dobkowski
Disclosures: Samsky and Jha report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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