A Prediction Model to Identify Patients at High Risk for 30-Day Readmission After Percutaneous Coronary Intervention

Wasfy, Jason H.; Rosenfield, Kenneth; Zelevinsky, Katya; Sakhuja, Rahul; Lovett, Ann; Spertus, John A.; Wimmer, Neil J.; Mauri, Laura; Normand, Sharon‐Lise T.; Yeh, Robert W.

doi:10.1161/circoutcomes.111.000093

Cited by 60 publications

(45 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Before PCI, using a homegrown, personalized, risk assessment program called Procedure Order Entry, a readmission risk score is calculated and presented to the provider 8 (Table). The risk score includes age, sex, admission status, insurance status, and comorbidities such as previous coronary artery bypass grafting, peripheral arterial disease, renal dysfunction, and lung disease.…”

Section: During Hospitalizationmentioning

confidence: 99%

“…7 Although these factors may not explain the entirety of variation in post-PCI readmission rates, they have been used to create a model that can predict readmissions. 7,8 Readmissions have also been shown to be preventable. 9 Few readmissions are because of procedural complications, so many PCI readmissions are related to medication choice and management, issues around access to outpatient care, and lack of timely assessment on re-presentation.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Clinical Interventions to Reduce Preventable Hospital Readmission After Percutaneous Coronary Intervention

Tanguturi

Temin

Yeh

et al. 2016

Circ: Cardiovascular Quality and Outcomes

Self Cite

View full text Add to dashboard Cite

Abstract-Hospital readmissions are common and costly and, in some cases, may be related to problems with care processes. We sought to reduce readmissions after percutaneous coronary intervention (PCI) in a large tertiary care facility through programs to target vulnerabilities predischarge, after discharge, and during re-presentation to the emergency department. During initial hospitalization, we assessed patients' readmission risk with a validated risk score and used a discharge checklist to ensure access to appropriate medications and close follow-up for high-risk patients. We also developed patient education videos about chest discomfort and heart failure. After discharge, we established a new follow-up clinic with cardiology fellows. A computerized system was developed to automatically notify cardiologists when patients presented to the emergency department within 30 days of PCI to enhance patient access to cardiology care in the emergency department. Early cardiologist assessment and assistance with triage was encouraged, and the emergency department used a risk stratification algorithm derived from a local database of patients to triage patients presenting with chest discomfort after PCI. We tracked the number of patients readmitted after PCI to our hospital. With our interventions, from 2011 to 2015, the index hospital readmission rate has declined from 9.6% to 5.3%. This program could provide tangible structural changes that can be implemented in other healthcare centers, both reducing the cost of care and improving the quality of care for patients with PCI. (Circ Cardiovasc Qual Outcomes. 2016;9:600-604.

show abstract

Section: During Hospitalizationmentioning

confidence: 99%

mentioning

confidence: 99%

Clinical Interventions to Reduce Preventable Hospital Readmission After Percutaneous Coronary Intervention

Tanguturi

Temin

Yeh

et al. 2016

Circ: Cardiovascular Quality and Outcomes

Self Cite

View full text Add to dashboard Cite

show abstract

“…In Massachusetts, selected covariates and outcomes are audited, adjudicated, and verified as previously described. 10 To obtain data on patients subsequent to discharge, including information on readmissions, we then linked data from the Massachusetts Data Analysis Center to hospital discharge billing data collected by the Massachusetts Division of Health Care Finance and Policy.…”

Section: Analysis Of Location Of Hospital Readmissionmentioning

confidence: 99%

“…Clinical characteristics of readmitted and not readmitted patients in the broader Massachusetts PCI population have been published previously. 10 …”

Section: What the Study Addsmentioning

confidence: 99%

Causes of Short-Term Readmission After Percutaneous Coronary Intervention

Wasfy

Strom

O’Brien

et al. 2014

Circ: Cardiovascular Interventions

Self Cite

View full text Add to dashboard Cite

R eadmission after inpatient hospitalization is common and costly. According to an analysis of Medicare claims data, 19.6% of Medicare patients discharged after a hospital admission during which percutaneous coronary intervention (PCI) is performed are readmitted within 30 days, and the Medicare Payment Advisory Commission has estimated that preventable readmissions cost Medicare as much as $12 billion per year. 1 The Affordable Care Act has created financial penalties for hospitals that have risk-adjusted readmission rates for specific conditions exceeding specific benchmarks. 2 Some have criticized this strategy, arguing that few readmissions are preventable and variation in readmission rates reflects differences in patient populations rather than hospital quality. 3 Despite these concerns, and driven by a need to improve care and lower costs, Medicare has begun implementing its value-based purchasing program to provide incentives for hospitals to reduce readmissions after acute myocardial infarction, pneumonia, and congestive heart failure. The Affordable Care Act empowers the Secretary of Health and Human Services to expand the applicable conditions beyond these 3 diagnoses in fiscal year 2015 to readmissions that represent conditions or procedures that are high volume or costly, 2 including chronic obstructive lung disease, coronary artery bypass grafting, vascular surgery, and PCI. 4 In 2011, the National Quality Forum endorsed 30-day readmission after PCI as an important quality measure, and hospitals that had chosen to participate in voluntary reporting had risk-adjusted readmission rates published publicly in the summer of 2013. 5 Editorial see p 9Background-Rehospitalization within 30 days after an admission for percutaneous coronary intervention (PCI) is common, costly, and a future target for Medicare penalties. Causes of readmission after PCI are largely unknown. Methods and Results-To illuminate the causes of PCI readmissions, patients with PCI readmitted within 30 days of discharge between 2007 and 2011 at 2 hospitals were identified, and their medical records were reviewed. Of 9288 PCIs, 9081 (97.8%) were alive at the end of the index hospitalization. Of these, 893 patients (9.8%) were readmitted within 30 days of discharge and included in the analysis. Among readmitted patients, 341 patients (38.1%) were readmitted for evaluation of recurrent chest pain or other symptoms concerning for angina, whereas 59 patients (6.6%) were readmitted for staged PCI without new symptoms. Complications of PCI accounted for 60 readmissions (6.7%). For cases in which chest pain or other symptoms concerning for angina prompted the readmission, 21 patients (6.2%) met criteria for myocardial infarction, and repeat PCI was performed in 54 patients (15.8%). The majority of chest pain patients (288; 84.4%) underwent ≥1 diagnostic imaging test, most commonly coronary angiography, and only 9 (2.6%) underwent target lesion revascularization. Conclusions-After PCI, readmissions within 30 days were seldom related to PCI comp...

show abstract

“…71 Black patients are more vulnerable to hospital readmission after AMI, CHF, and PCI. 72,73 Public reporting in New York may have exacerbated racial disparities in access to care for CABG (Figure 4). 74 Public reporting of worse results for hospitals that serve minorities, rural populations, and vulnerable populations may drive patients away from those hospitals or decrease reimbursement for care at such centers, worsening financial constraints that could exacerbate genuine quality problems at those institutions.…”

Section: Unintended Consequences Of Public Reportingmentioning

confidence: 99%