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Background-Readmission soon after hospital discharge is an expensive and often preventable event for patients with heart failure. We present a model approved by the National Quality Forum for the purpose of public reporting of hospital-level readmission rates by the Centers for Medicare & Medicaid Services. Methods and Results-We developed a hierarchical logistic regression model to calculate hospital risk-standardized 30-day all-cause readmission rates for patients hospitalized with heart failure. The model was derived with the use of Medicare claims data for a 2004 cohort and validated with the use of claims and medical record data. The unadjusted readmission rate was 23.6%. The final model included 37 variables, had discrimination ranging from 15% observed 30-day readmission rate in the lowest predictive decile to 37% in the upper decile, and had a c statistic of 0.60. The 25th and 75th percentiles of the risk-standardized readmission rates across 4669 hospitals were 23.1% and 24.0%, with 5th and 95th percentiles of 22.2% and 25.1%, respectively. The odds of all-cause readmission for a hospital 1 standard deviation above average was 1.30 times that of a hospital 1 standard deviation below average. State-level adjusted readmission rates developed with the use of the claims model are similar to rates produced for the same cohort with the use of a medical record model (correlation, 0.97; median difference, 0.06 percentage points). Conclusions-This claims-based model of hospital risk-standardized readmission rates for heart failure patients produces estimates that may serve as surrogates for those derived from a medical record model. (Circ Cardiovasc Qual Outcomes.

Context For more than a decade, hospitals have focused on decreasing length of stay but this focus may have had unanticipated effects on patient care. Objective To describe the temporal changes in length of stay, discharge disposition, and short-term outcomes among older patients hospitalized for heart failure. Methods Observational study of Medicare fee-for-service hospitalizations for heart failure between 1993 and 2008, with a 30-day follow-up. Main Outcome Measures Length of hospital stay, in-patient and 30-day mortality, and 30-day readmission rates. Results Between 1993 and 2008, 7,799,788 hospitalizations were studied. Length of stay decreased from 8.8 (95% CI, 8.8–8.8) to 6.3 (95% CI, 6.3–6.3) days. In-hospital mortality decreased by half, from 8.5% (95%CI, 8.4–8.6) in 1993 to 4.2% (95%CI, 4.2–4.3%) in 2008, whereas 30-day mortality decreased by 17%, from 12.8% (95%CI, 12.8–12.9%) to 10.9% (95%CI, 10.8–10.9%). Rates of discharge to home decreased 10% (from 74.4% to 66.9%), while discharges to skilled nursing facilities increased 65%, from 13% to 21.3%. Thirty-day readmission rates increased 27%, from 17.2% (95%CI, 17.1–17.3%) relative to 21.9% (95%CI, 21.8–22.0%) (all p values <0.001). Consistent with our unadjusted analyses, 2007–2008 risk-adjusted 30-day mortality risk was 0.86 (95% CI, 0.86–0.87) when compared with 1993–1994, while the 30-day readmission risk ratio was 1.19 (95%CI, 1.18–1.21). Conclusions For patients admitted with heart failure over the past 16 years, we observed reductions in length of stay and in-hospital mortality, less marked reductions in 30-day mortality, and increases in 30-day readmission rates and use of skilled nursing facilities after discharge.