Association of an Acute Myocardial Infarction Readmission-Reduction Program With Mortality and Readmission

Abstract

Background: Reducing hospital readmission after acute myocardial infarction (AMI) has the potential to both improve quality and reduce costs. As such, readmission after AMI has been a target of financial penalties through Medicare. However, substantial concern exists about potential adverse effects and efficacious readmission-reduction strategies are not well validated. Methods and Results: We started an AMI readmissions reduction program in November 2017. Between July 2016 and February 2019, hospital billing data were queried to detect all inpatient hospitalizations at the Massachusetts General Hospital for AMI. Thirty-day readmission was identified through hospital billing data, and mortality was extracted from our electronic health record. The data set was merged with claims data for patients in accountable care organizations to detect readmission at other hospitals. We performed segmented linear regression, adjusting for secular trend and case mix, to assess the independent association of our program on both outcome variables. After inclusion and exclusion criteria were applied, the study population included 2020 patients. The overall 30-day readmission rate was higher before the intervention than after the intervention (15.5% versus 10.7%, P =0.002). The overall 30-day mortality rate was similar in both time periods (1.8% versus 1.4%, P =0.457). The program was associated with initial reduction in 30-day readmission (−9.8%, P =0.0002) and 30-day mortality (−2.6%, P =0.041). The program did not change trend in 30-day readmission (+0.19% readmissions/mo, P =0.554) and trend in 30-day mortality (−0.21% deaths/mo, P =0.119). Conclusions: An AMI readmissions reduction program that increases outpatient and emergency department (ED) access to cardiology care is associated with reduced 30-day readmission and 30-day mortality. Similar statistical techniques can be used to conduct a rigorous, mechanistic program evaluation of other quality improvement initiatives.

Innovative Managed Care May Be Related to Improved Prognosis for Acute Myocardial Infarction Survivors

“…[25][26][27] However, the financial penalties may not be related to improved survival. 28,29 To the best of our knowledge, the present analysis is the first premise that financial incentives may contribute to a better prognosis of MI survivors through improved access to life-saving procedures, and possibly higher quality of medical care.…”

Association of an Automated Blood Pressure Measurement Quality Improvement Program With Terminal Digit Preference and Recorded Mean Blood Pressure in 11 Clinics

“…Although accountability programs may be associated with improvement in care processes and outcomes, they may also be associated with unexpected consequences. For example, requiring the administration of antibiotics within 4 hours for community-acquired pneumonia has been associated with an increase in misdiagnoses .…”

“…Although the validity and reliability of BP measurements obtained with the Omron HEM-907XL are well documented, [29][30][31][41][42][43][44][45] many licensed practitioners (physicians, physician assistants, and advanced practice registered nurses) believe that manual measurement of BP is highly accurate and that automated measurement is not accurate or not very accurate. 46 Although accountability programs may be associated with improvement in care processes and outcomes, [47][48][49] they may also be associated with unexpected consequences. For example, requiring the administration of antibiotics within 4 hours for community-acquired pneumonia has been associated with an increase in misdiagnoses.…”

Real-World Use and Outcomes of Oral Antiplatelets Among Patients with Acute Coronary Syndrome: A Retrospective Cohort Study

“…Multivariate logistic regression analysis was performed to estimate the association of the type of study medication used with the odds of ACS-related inpatient readmissions, controlling for the [7,8]. Dyspnea and bleeding, which may be more common with ticagrelor, are associated with higher readmission rates [3,9]. Likewise, medication nonadherence, which may be greater for branded products with higher co-pays, is associated with higher readmissions [10].…”