Diagnoses and Timing of 30-Day Readmissions after Hospitalization For Heart Failure, Acute Myocardial Infarction, or Pneumonia
Identifieur interne : 000199 ( Pmc/Corpus ); précédent : 000198; suivant : 000200Diagnoses and Timing of 30-Day Readmissions after Hospitalization For Heart Failure, Acute Myocardial Infarction, or Pneumonia
Auteurs : Kumar Dharmarajan ; Angela F. Hsieh ; Zhenqiu Lin ; Héctor Bueno ; Joseph S. Ross ; Leora I. Horwitz ; José Augusto Barreto-Filho ; Nancy Kim ; Susannah M. Bernheim ; Lisa G. Suter ; Elizabeth E. Drye ; Harlan M. KrumholzSource :
- JAMA : the journal of the American Medical Association [ 0098-7484 ] ; 2013.
Abstract
To better guide strategies intended to reduce high rates of 30-day readmission after hospitalization for heart failure, acute myocardial infarction, or pneumonia, further information is needed about readmission diagnoses, readmission timing, and the relationship of both to patient age, sex, and race.
To examine readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after hospitalization for heart failure, acute myocardial infarction, or pneumonia.
We analyzed 2007 to 2009 Medicare Fee-For-Service claims data to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare & Medicaid Services’ Condition Categories. Readmission timing was determined by day after discharge.
We examined (1) the percentage of 30-day readmissions occurring on each day (0–30) after discharge; (2) the most common readmission diagnoses occurring during cumulative time periods (days 0–3, 0–7, 0–15, and 0–30) and consecutive time periods (days 0–3, 4–7, 8–15, and 16–30) after hospitalization; (3) median time to readmission for common readmission diagnoses; and (4) the relationship between patient demographic characteristics and readmission diagnoses and timing.
From 2007 to 2009, we identified 329,308 30-day readmissions after 1,330,157 heart failure hospitalizations (24.8% readmitted), 108,992 30-day readmissions after 548,834 acute myocardial infarction hospitalizations (19.9% readmitted), and 214,239 30-day readmissions after 1,168,624 pneumonia hospitalizations (18.3% readmitted). The proportion of patients readmitted for the same condition was 35.2% after index heart failure hospitalization, 10.0% after index acute myocardial infarction hospitalization, and 22.4% after index pneumonia hospitalization. Of all readmissions within 30 days, 61.0%, 67.6%, and 62.6% occurred with 15 days of discharge after hospitalization for heart failure, acute myocardial infarction, or pneumonia, respectively. The diverse spectrum of readmission diagnoses was largely similar in both cumulative (days 0–3, 0–7, 0–15, and 0–30) and consecutive (days 0–3, 4–7, 8–15, and 16–30) time periods after discharge. Median time to 30-day readmission was 12 days, 10 days, and 12 days for patients initially hospitalized with heart failure, acute myocardial infarction, or pneumonia, respectively, and was comparable across common readmission diagnoses. Neither readmission diagnoses nor timing substantively varied by age, sex, or race.
Among Medicare Fee-for-Service beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia, 30-day readmissions are frequent throughout the month following hospitalization and result from a similar spectrum of readmission diagnoses regardless of age, sex, race, or time after discharge.
Url:
DOI: 10.1001/jama.2012.216476
PubMed: 23340637
PubMed Central: 3688083
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PMC:3688083Le document en format XML
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<author><name sortKey="Dharmarajan, Kumar" sort="Dharmarajan, Kumar" uniqKey="Dharmarajan K" first="Kumar" last="Dharmarajan">Kumar Dharmarajan</name>
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<author><name sortKey="Hsieh, Angela F" sort="Hsieh, Angela F" uniqKey="Hsieh A" first="Angela F." last="Hsieh">Angela F. Hsieh</name>
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<author><name sortKey="Lin, Zhenqiu" sort="Lin, Zhenqiu" uniqKey="Lin Z" first="Zhenqiu" last="Lin">Zhenqiu Lin</name>
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<author><name sortKey="Bueno, Hector" sort="Bueno, Hector" uniqKey="Bueno H" first="Héctor" last="Bueno">Héctor Bueno</name>
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<author><name sortKey="Ross, Joseph S" sort="Ross, Joseph S" uniqKey="Ross J" first="Joseph S." last="Ross">Joseph S. Ross</name>
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<author><name sortKey="Horwitz, Leora I" sort="Horwitz, Leora I" uniqKey="Horwitz L" first="Leora I." last="Horwitz">Leora I. Horwitz</name>
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<author><name sortKey="Barreto Filho, Jose Augusto" sort="Barreto Filho, Jose Augusto" uniqKey="Barreto Filho J" first="José Augusto" last="Barreto-Filho">José Augusto Barreto-Filho</name>
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<author><name sortKey="Kim, Nancy" sort="Kim, Nancy" uniqKey="Kim N" first="Nancy" last="Kim">Nancy Kim</name>
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<author><name sortKey="Bernheim, Susannah M" sort="Bernheim, Susannah M" uniqKey="Bernheim S" first="Susannah M." last="Bernheim">Susannah M. Bernheim</name>
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<author><name sortKey="Suter, Lisa G" sort="Suter, Lisa G" uniqKey="Suter L" first="Lisa G." last="Suter">Lisa G. Suter</name>
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<author><name sortKey="Drye, Elizabeth E" sort="Drye, Elizabeth E" uniqKey="Drye E" first="Elizabeth E." last="Drye">Elizabeth E. Drye</name>
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<author><name sortKey="Krumholz, Harlan M" sort="Krumholz, Harlan M" uniqKey="Krumholz H" first="Harlan M." last="Krumholz">Harlan M. Krumholz</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Diagnoses and Timing of 30-Day Readmissions after Hospitalization For Heart Failure, Acute Myocardial Infarction, or Pneumonia</title>
<author><name sortKey="Dharmarajan, Kumar" sort="Dharmarajan, Kumar" uniqKey="Dharmarajan K" first="Kumar" last="Dharmarajan">Kumar Dharmarajan</name>
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<author><name sortKey="Hsieh, Angela F" sort="Hsieh, Angela F" uniqKey="Hsieh A" first="Angela F." last="Hsieh">Angela F. Hsieh</name>
</author>
<author><name sortKey="Lin, Zhenqiu" sort="Lin, Zhenqiu" uniqKey="Lin Z" first="Zhenqiu" last="Lin">Zhenqiu Lin</name>
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<author><name sortKey="Bueno, Hector" sort="Bueno, Hector" uniqKey="Bueno H" first="Héctor" last="Bueno">Héctor Bueno</name>
</author>
<author><name sortKey="Ross, Joseph S" sort="Ross, Joseph S" uniqKey="Ross J" first="Joseph S." last="Ross">Joseph S. Ross</name>
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<author><name sortKey="Horwitz, Leora I" sort="Horwitz, Leora I" uniqKey="Horwitz L" first="Leora I." last="Horwitz">Leora I. Horwitz</name>
</author>
<author><name sortKey="Barreto Filho, Jose Augusto" sort="Barreto Filho, Jose Augusto" uniqKey="Barreto Filho J" first="José Augusto" last="Barreto-Filho">José Augusto Barreto-Filho</name>
</author>
<author><name sortKey="Kim, Nancy" sort="Kim, Nancy" uniqKey="Kim N" first="Nancy" last="Kim">Nancy Kim</name>
</author>
<author><name sortKey="Bernheim, Susannah M" sort="Bernheim, Susannah M" uniqKey="Bernheim S" first="Susannah M." last="Bernheim">Susannah M. Bernheim</name>
</author>
<author><name sortKey="Suter, Lisa G" sort="Suter, Lisa G" uniqKey="Suter L" first="Lisa G." last="Suter">Lisa G. Suter</name>
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<author><name sortKey="Drye, Elizabeth E" sort="Drye, Elizabeth E" uniqKey="Drye E" first="Elizabeth E." last="Drye">Elizabeth E. Drye</name>
</author>
<author><name sortKey="Krumholz, Harlan M" sort="Krumholz, Harlan M" uniqKey="Krumholz H" first="Harlan M." last="Krumholz">Harlan M. Krumholz</name>
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<series><title level="j">JAMA : the journal of the American Medical Association</title>
<idno type="ISSN">0098-7484</idno>
<idno type="eISSN">1538-3598</idno>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Context</title>
<p id="P1">To better guide strategies intended to reduce high rates of 30-day readmission after hospitalization for heart failure, acute myocardial infarction, or pneumonia, further information is needed about readmission diagnoses, readmission timing, and the relationship of both to patient age, sex, and race.</p>
</sec>
<sec id="S2"><title>Objective</title>
<p id="P2">To examine readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after hospitalization for heart failure, acute myocardial infarction, or pneumonia.</p>
</sec>
<sec id="S3"><title>Design, Setting, and Patients</title>
<p id="P3">We analyzed 2007 to 2009 Medicare Fee-For-Service claims data to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare & Medicaid Services’ Condition Categories. Readmission timing was determined by day after discharge.</p>
</sec>
<sec id="S4"><title>Main Outcomes Measures</title>
<p id="P4">We examined (1) the percentage of 30-day readmissions occurring on each day (0–30) after discharge; (2) the most common readmission diagnoses occurring during cumulative time periods (days 0–3, 0–7, 0–15, and 0–30) and consecutive time periods (days 0–3, 4–7, 8–15, and 16–30) after hospitalization; (3) median time to readmission for common readmission diagnoses; and (4) the relationship between patient demographic characteristics and readmission diagnoses and timing.</p>
</sec>
<sec id="S5"><title>Results</title>
<p id="P5">From 2007 to 2009, we identified 329,308 30-day readmissions after 1,330,157 heart failure hospitalizations (24.8% readmitted), 108,992 30-day readmissions after 548,834 acute myocardial infarction hospitalizations (19.9% readmitted), and 214,239 30-day readmissions after 1,168,624 pneumonia hospitalizations (18.3% readmitted). The proportion of patients readmitted for the same condition was 35.2% after index heart failure hospitalization, 10.0% after index acute myocardial infarction hospitalization, and 22.4% after index pneumonia hospitalization. Of all readmissions within 30 days, 61.0%, 67.6%, and 62.6% occurred with 15 days of discharge after hospitalization for heart failure, acute myocardial infarction, or pneumonia, respectively. The diverse spectrum of readmission diagnoses was largely similar in both cumulative (days 0–3, 0–7, 0–15, and 0–30) and consecutive (days 0–3, 4–7, 8–15, and 16–30) time periods after discharge. Median time to 30-day readmission was 12 days, 10 days, and 12 days for patients initially hospitalized with heart failure, acute myocardial infarction, or pneumonia, respectively, and was comparable across common readmission diagnoses. Neither readmission diagnoses nor timing substantively varied by age, sex, or race.</p>
</sec>
<sec id="S6"><title>Conclusions</title>
<p id="P6">Among Medicare Fee-for-Service beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia, 30-day readmissions are frequent throughout the month following hospitalization and result from a similar spectrum of readmission diagnoses regardless of age, sex, race, or time after discharge.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">7501160</journal-id>
<journal-id journal-id-type="pubmed-jr-id">5346</journal-id>
<journal-id journal-id-type="nlm-ta">JAMA</journal-id>
<journal-id journal-id-type="iso-abbrev">JAMA</journal-id>
<journal-title-group><journal-title>JAMA : the journal of the American Medical Association</journal-title>
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<issn pub-type="ppub">0098-7484</issn>
<issn pub-type="epub">1538-3598</issn>
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<article-meta><article-id pub-id-type="pmid">23340637</article-id>
<article-id pub-id-type="pmc">3688083</article-id>
<article-id pub-id-type="doi">10.1001/jama.2012.216476</article-id>
<article-id pub-id-type="manuscript">NIHMS456737</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Diagnoses and Timing of 30-Day Readmissions after Hospitalization For Heart Failure, Acute Myocardial Infarction, or Pneumonia</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Dharmarajan</surname>
<given-names>Kumar</given-names>
</name>
<degrees>MD, MBA</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Hsieh</surname>
<given-names>Angela F.</given-names>
</name>
<degrees>PhD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Lin</surname>
<given-names>Zhenqiu</given-names>
</name>
<degrees>PhD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Bueno</surname>
<given-names>Héctor</given-names>
</name>
<degrees>MD, PhD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Ross</surname>
<given-names>Joseph S.</given-names>
</name>
<degrees>MD, MHS</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Horwitz</surname>
<given-names>Leora I.</given-names>
</name>
<degrees>MD, MHS</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Barreto-Filho</surname>
<given-names>José Augusto</given-names>
</name>
<degrees>MD, PhD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Kim</surname>
<given-names>Nancy</given-names>
</name>
<degrees>MD, PhD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Bernheim</surname>
<given-names>Susannah M.</given-names>
</name>
<degrees>MD, MHS</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Suter</surname>
<given-names>Lisa G.</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Drye</surname>
<given-names>Elizabeth E.</given-names>
</name>
<degrees>MD, SM</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Krumholz</surname>
<given-names>Harlan M.</given-names>
</name>
<degrees>MD, SM</degrees>
</contrib>
<aff id="A1">From the Division of Cardiology (KD), Department of Internal Medicine, Columbia University Medical Center, New York, NY; Center for Outcomes Research and Evaluation (KD, AFH, ZL, JSR, LIH, JAB-F, NK, SMB, EED, HMK), Yale-New Haven Hospital, New Haven, CT; Department of Cardiology (HB), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Sections of General Internal Medicine (JSR, LIH, NK) and Cardiovascular Medicine (HMK) and the Robert Wood Johnson Clinical Scholars Program (JSR, HMK), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Section of Health Policy and Administration, School of Public Health (HMK), New Haven, CT</aff>
</contrib-group>
<author-notes><corresp id="FN1">Corresponding Author: Harlan Krumholz, 1 Church Street, Suite 200, New Haven, CT 06510 203-764-5885 (f) 203-764-5653; <email>harlan.krumholz@yale.edu</email>
</corresp>
<fn id="FN2" fn-type="current-aff"><p>Dr. Barreto-Filho is currently affiliated with the Federal University of Sergipe, Brazil.</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>28</day>
<month>3</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="ppub"><day>23</day>
<month>1</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>20</day>
<month>6</month>
<year>2013</year>
</pub-date>
<volume>309</volume>
<issue>4</issue>
<fpage>355</fpage>
<lpage>363</lpage>
<abstract><sec id="S1"><title>Context</title>
<p id="P1">To better guide strategies intended to reduce high rates of 30-day readmission after hospitalization for heart failure, acute myocardial infarction, or pneumonia, further information is needed about readmission diagnoses, readmission timing, and the relationship of both to patient age, sex, and race.</p>
</sec>
<sec id="S2"><title>Objective</title>
<p id="P2">To examine readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after hospitalization for heart failure, acute myocardial infarction, or pneumonia.</p>
</sec>
<sec id="S3"><title>Design, Setting, and Patients</title>
<p id="P3">We analyzed 2007 to 2009 Medicare Fee-For-Service claims data to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare & Medicaid Services’ Condition Categories. Readmission timing was determined by day after discharge.</p>
</sec>
<sec id="S4"><title>Main Outcomes Measures</title>
<p id="P4">We examined (1) the percentage of 30-day readmissions occurring on each day (0–30) after discharge; (2) the most common readmission diagnoses occurring during cumulative time periods (days 0–3, 0–7, 0–15, and 0–30) and consecutive time periods (days 0–3, 4–7, 8–15, and 16–30) after hospitalization; (3) median time to readmission for common readmission diagnoses; and (4) the relationship between patient demographic characteristics and readmission diagnoses and timing.</p>
</sec>
<sec id="S5"><title>Results</title>
<p id="P5">From 2007 to 2009, we identified 329,308 30-day readmissions after 1,330,157 heart failure hospitalizations (24.8% readmitted), 108,992 30-day readmissions after 548,834 acute myocardial infarction hospitalizations (19.9% readmitted), and 214,239 30-day readmissions after 1,168,624 pneumonia hospitalizations (18.3% readmitted). The proportion of patients readmitted for the same condition was 35.2% after index heart failure hospitalization, 10.0% after index acute myocardial infarction hospitalization, and 22.4% after index pneumonia hospitalization. Of all readmissions within 30 days, 61.0%, 67.6%, and 62.6% occurred with 15 days of discharge after hospitalization for heart failure, acute myocardial infarction, or pneumonia, respectively. The diverse spectrum of readmission diagnoses was largely similar in both cumulative (days 0–3, 0–7, 0–15, and 0–30) and consecutive (days 0–3, 4–7, 8–15, and 16–30) time periods after discharge. Median time to 30-day readmission was 12 days, 10 days, and 12 days for patients initially hospitalized with heart failure, acute myocardial infarction, or pneumonia, respectively, and was comparable across common readmission diagnoses. Neither readmission diagnoses nor timing substantively varied by age, sex, or race.</p>
</sec>
<sec id="S6"><title>Conclusions</title>
<p id="P6">Among Medicare Fee-for-Service beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia, 30-day readmissions are frequent throughout the month following hospitalization and result from a similar spectrum of readmission diagnoses regardless of age, sex, race, or time after discharge.</p>
</sec>
</abstract>
<funding-group><award-group><funding-source country="United States">National Heart, Lung, and Blood Institute : NHLBI</funding-source>
<award-id>U01 HL105270 || HL</award-id>
</award-group>
<award-group><funding-source country="United States">National Institute on Aging : NIA</funding-source>
<award-id>K08 AG038336 || AG</award-id>
</award-group>
<award-group><funding-source country="United States">National Institute on Aging : NIA</funding-source>
<award-id>K08 AG032886 || AG</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
</record>
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