Readmission in the 30 Days After Percutaneous Coronary Intervention

Yost, Gregory; Puher, Stefanie L.; Graham, Jove; Scott, Thomas D.; Skelding, Kimberly A.; Berger, Peter B.; Blankenship, James C.

doi:10.1016/j.jcin.2012.10.015

Cited by 57 publications

(53 citation statements)

References 14 publications

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“…First, we have shown that evaluations of chest pain or symptoms concerning for angina, by far, constitute the largest proportion of readmissions (38.1%) within 30 days. These results confirm and extend the results of a recent study 9 that found 26.7% of readmissions evaluate chest pain or other symptoms concerning for angina (adding unstable angina, non-ST-segment-elevation myocardial infarction, stable angina, noncardiac chest pain, and pericarditis) and support the generalizability of our findings. Among patients readmitted with chest pain or possible angina, a large proportion received diagnostic imaging during the readmission, with more than half undergoing repeat coronary angiography.…”

Section: Discussionsupporting

confidence: 92%

“…Although administrative claims databases have been used to categorize readmission discharge diagnoses broadly, [6][7][8] few studies have been conducted using detailed medical record reviews to characterize patient presentations for readmission, the care received or the associated use of resources during these hospitalizations. 9 To address this gap in knowledge, we sought to characterize reasons for 30-day readmission after PCI through detailed exploration of the medical records at 2 hospitals within a large integrated healthcare system. We further examined the use of diagnostic testing and therapeutic procedures for the most common causes of readmission.…”

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confidence: 99%

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Causes of Short-Term Readmission After Percutaneous Coronary Intervention

Wasfy

Strom

O’Brien

et al. 2014

Circ: Cardiovascular Interventions

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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...

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Causes of Short-Term Readmission After Percutaneous Coronary Intervention

Wasfy

Strom

O’Brien

et al. 2014

Circ: Cardiovascular Interventions

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“…5 Currently, readmission rates vary widely, ranging from 8% to 15%, and within one state, it varied significantly between hospitals, with some having readmission rates to the index hospital as low as 9% and others as high as 22%. 2,6 The cause of this wide variation is likely multifactorial. Certain patient characteristics and clinical factors such as sex, race, discharge to a nursing home, longer length of stay, certain comorbidities, lack of insurance or Medicare or Medicaid use, and peri-and postprocedural complications have been associated with higher risks of readmission.…”

mentioning

confidence: 99%

“…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. 6,9 As such, nonprocedural care may substantially affect this procedural metric.…”

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

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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.

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“…In particular, a medical record review of 262 early PCI readmissions at Geisinger Medical Center in Danville, Pennsylvania, demonstrated that only 11.9% of readmissions are related to procedural complications. 12 By contrast, 40.2% of early readmissions were considered unrelated to the index admission, including noncardiac chest discomfort. A similar analysis within the Partners Healthcare system in Boston, Massachusetts, demonstrated compatible results with only 6.7% of readmissions related to procedural complications and 38.1% of readmissions for chest discomfort or other symptoms concerning for angina without immediately obvious stent thrombosis.…”

Section: Limitations Of the Pci Readmission Performance Metricmentioning

confidence: 99%

Future of the PCI Readmission Metric

Wasfy

Yeh

2016

Circ: Cardiovascular Quality and Outcomes

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Abstract-Between 2013 and 2014, the Centers for Medicare and Medicaid Services and the National Cardiovascular DataRegistry publically reported risk-adjusted 30-day readmission rates after percutaneous coronary intervention (PCI) as a pilot project. A key strength of this public reporting effort included risk adjustment with clinical rather than administrative data. Furthermore, because readmission after PCI is common, expensive, and preventable, this metric has substantial potential to improve quality and value in American cardiology care. Despite this, concerns about the metric exist. For example, few PCI readmissions are caused by procedural complications, limiting the extent to which improved procedural technique can reduce readmissions. Also, similar to other readmission measures, PCI readmission is associated with socioeconomic status and race. Accordingly, the metric may unfairly penalize hospitals that care for underserved patients. Perhaps in the context of these limitations, Centers for Medicare and Medicaid Services has not yet included PCI readmission among metrics that determine Medicare financial penalties. Nevertheless, provider organizations may still wish to focus on this metric to improve value for cardiology patients. PCI readmission is associated with low-risk chest discomfort and patient anxiety. Therefore, patient education, improved triage mechanisms, and improved care coordination offer opportunities to minimize PCI readmissions. Because PCI readmission is common and costly, reducing PCI readmission offers provider organizations a compelling target to improve the quality of care, and also performance in contracts involve shared financial risk. (Circ Cardiovasc Qual Outcomes. 2016;9:186-189.

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Readmission in the 30 Days After Percutaneous Coronary Intervention

Abstract: Readmissions within 30 days due to complications related to PCI performed on index admission are rare (0.9% of all PCI) and are an infrequent cause of readmission (<12% of readmissions). Thirty-day readmission after PCI should not be used as a quality metric of PCI performance.

Cited by 57 publications

References 14 publications

Causes of Short-Term Readmission After Percutaneous Coronary Intervention

Causes of Short-Term Readmission After Percutaneous Coronary Intervention

Clinical Interventions to Reduce Preventable Hospital Readmission After Percutaneous Coronary Intervention

Future of the PCI Readmission Metric

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