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Mortality, readmission rates not associated for MI or pneumonia
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Among patients hospitalized for acute myocardial infarction or pneumonia, the mortality rates and readmission rates were not linked, according to recent data published in the Journal of the American Medical Association.
“Our hypothesis was that these measures would not be strongly related because the factors that influence the risk of mortality are different from those that influence the risk of adverse events and readmission after discharge,” Harlan Krumholz, MD, Harold H. Hines Jr. Professor of Medicine at Yale School of Medicine, told Infectious Disease News. “The study should reassure hospitals and clinicians that doing well on mortality rates will not impose a disadvantage for readmission rates. We failed to find evidence that hospitals cannot excel on both.”
Harlan Krumholz
Krumholz and colleagues evaluated the 30-day, all-cause, risk-standardized mortality rates and the 30-day, all-cause, risk-standardized readmission rates for acute MI, heart failure and pneumonia. They studied Medicare fee-for-service beneficiaries who were discharged from July 1, 2005, to June 30, 2008. For acute MI, the sample included 4,506 hospitals; for heart failure, the sample included 4,767 hospitals; and for pneumonia, there were 4,811 hospitals.
The mean mortality and readmission rates for pneumonia were 11.64% and 18.22%, respectively. The correlation between mortality rates and readmission rates was 0.002 (95% CI, –0.03 to 0.03). For acute MI, the mortality rate was 16.6% and the readmission rate was 19.94%. The correlation between the rates was 0.03 (95% CI, –0.002 to 0.06). For heart failure, the mortality and readmission rates were 11.17% and 24.56%, respectively, and the correlation between the two was –0.17 (95% CI, –0.2 to –0.14).
“How well a hospital performed on mortality did not dictate its performance in readmission,” Krumholz said. “Some experts have expressed concern that it was not possible to do well on both measures. We dispel that concern.”
Krumholz and colleagues are now looking to better understand the factors that best promote outstanding performance on both measures. They are also seeking to better characterize the period of transient risk that patients experience after discharge — the post-hospital syndrome — and how that relates to quality of care.
Harlan Krumholz, MD, can be reached at the Department of Internal Medicine/Section of Cardiovascular Medicine, Yale University School of Medicine, 1 Church St., Suite 200, New Haven, CT 06510; email: Harlan.krumholz@yale.edu.
Disclosure: Krumholz is the recipient of a research grant from Medtronic and chairs a cardiac scientific advisory board for UnitedHealth.
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