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Psychiatric comorbidities impact hospital readmissions for HF, AMI, pneumonia

Psychiatric comorbidities increased the rate of hospital readmissions after initial hospitalizations for heart failure, acute myocardial infarction or pneumonia, which are the three conditions used by CMS to penalize hospitals with high readmission rates, according to recent findings.

“CMS chose three general medical conditions — heart failure, acute myocardial infarction and pneumonia — as a way of assessing excessive re-hospitalizations and penalizing providers by reducing payment for healthcare services,” Henry Ford researcher Brian K. Ahmedani, PhD, of the Center for Health Policy and Health Services Research, said in a press release. “The policy was adopted as a way to curb rising healthcare costs and improve quality of care, and CMS chose those three conditions because they're common, expensive to treat, and often result in readmission.”

In the study, Ahmedani and colleagues evaluated data from the Mental Health Research Network (MHRN), a consortium of 11 large healthcare systems with affiliated insurance plans, which are part of the HMO Research Network Virtual Data Warehouse. The MHRN systems serve over 11 million individuals. The study sample included all (n = 160,169) hospitalizations at participating health systems for heart failure (HF), acute myocardial infarction (MI), or pneumonia between January 2009 and December 2011.

The researchers used ICD-9 codes to identify psychiatric comorbidities for mental disorders. Patients were considered to have a psychiatric condition if they received the same diagnosis on at least two occasions during the 12 month period prior to and including the inpatient discharge date. The researchers defined a 30-day readmission as admission for any cause to any hospital that occurred no more than 30 days after discharge from the initial admission for HF, acute MI, or pneumonia. All-cause 30-day readmission was the study’s outcome variable.

The researchers found that 30-day readmission occurred in 18% of all patients initially hospitalized for HF, acute MI, or pneumonia. The readmission rate was 5% higher among patients with psychiatric comorbidities (21.7%) vs. those without (16.5%; P < .001). A relationship between depression, anxiety and dementia and higher readmission rates was seen in patients with index hospitalizations for each of the three specified conditions, as well as for a pooled combination of all three conditions (P < .05). In patients with index admissions for HF and pneumonia, substance use and bipolar disorders were related to higher rates of readmissions (P < .05). There was an overall decrease in readmission rates between 2009 and 2011.

According to the researchers, the relationship between psychiatric conditions and physical conditions such as HF, acute MI and pneumonia is bidirectional, and therefore psychiatric conditions should be factored in when monitoring readmissions. Additionally, because psychiatric conditions often go undiagnosed, the study may have underestimated the interaction between psychiatric conditions and physical illness requiring hospitalization.

“Because depression, anxiety and substance abuse appeared to be the most common diagnoses among the patients we studied, and because each was associated with increased readmission rates, these disorders may be the most appropriate for healthcare systems to focus their primary screening efforts,” Ahmedani said in the press release. — by Jennifer Byrne

Disclosures: The researchers report no relevant financial disclosures.