Broken Hearts
On average, nearly 20% of the 1 million heart failure patients admitted to U.S. hospitals each year are readmitted within a month. Heart failure is the leading cause of those readmissions, which overall cost Medicare $17 billion every year and amount to 20% of all Medicare payments, government data show.
Baylor Heart and Vascular Hospital in Dallas led the nation with a low readmission rate of just under 16%, while Lincoln Medical and Mental Health Center in the Bronx came in last nationwide by readmitting 34% of its heart failure patients in 30 days.
Full article on proper outpatient care for heart patients.
Chart source: Journal of the American Medical Association (gated, but with abstract)
I believe the issue on the chart is this: The longer you go without seeing a doctor after discharge, the more likely you are to be readmitted.
It could also mean that the most frail people show problems right away while others take four weeks or more to develop. We don’t know.
The study looked at all-cause readmission, not at readmission for things related to the first admission.
According to the abstract, the whole sample readmission rate was 21.3% in thirty days and more than a third of the sample, 38.3 percent of patients, had early follow-up. It doesn’t say what follow-up was. A phone call? A visit? The USA today article specified hospital follow-up. What if the patient followed-up with a private cardiologist? Did that count?
The hospitals were divided into quartiles of early follow-up. In the hospitals with the lowest quartile of early follow-up the rate of 30 day admission was 23.3 percent. In the hospital with the highest rate of early follow-up the rate of readmission was 20.9 percent. So, early follow-up had slightly lower than average readmission and others had slightly higher rates of readmission.
What does this mean? It means that one had better know a whole lot about the cause of the readmissions, age distributions, and possible comorbidities before concluding much of anything. And about whether the Medicare person might have had coverage in a gatekeeper setting that made being readmitted more difficult.
Linda, I really love the way you hold the researchers’ feet to the fire. Thoughtful critique.
There is also the issue of medicine being practiced in different ways by different doctors and different institutions. The chart suggests that some practices may be better than others.