Congestive Heart Failure Performance Measures: Does Adherence Impact Early Unplanned Hospital Readmissions?

Abstract

Background: Congestive heart failure (CHF) is the most common Medicare diagnosis related group accounting for more healthcare costs than any other disease condition. Total annual healthcare expenditure for both direct and indirect healthcare cost of CHF approach 28 billion dollars. CHF readmissions contribute significantly to this expenditure. Quality of care in heart failure has been linked to clinical and process based performance measures. This study evaluated the relationship between adherence to heart failure performance metrics and 30 day readmission rates. Methods: This was a single center retrospective case-control study that evaluated 6063 consecutive patients admitted with a diagnosis of CHF from December 2001 through December 2008.Data was collected for readmission to the hospital within 30 days and compliance to the heart failure performance measures at discharge. Results: The rate of readmission for CHF increased steadily from 16.8% in 2002 to 24.8% in 2008, while adherence to the four CHF performance measures increased concurrently during the same time frame from 88.7% to 98.9%.Except for left ventricular function (LVF) assessment, 30 day readmission rate was not associated with adherence to any other performance measures. Readmitted patients had twice the odds of not having their LVF assessed (OR, 2.02; p<0.000016, 95% confidence interval 1.50-2.72) Conclusions: Heart failure performance measures, except for the assessment of left ventricular function have little relationship with 30 day hospital readmissions after discharge. More studies need to be done to identify performance measures that correlate with quality of care in heart failure patients.