1055 — Trends in Risk-Adjusted 30-Day Mortality and Readmission for VA Patients Hospitalized with Heart Failure

Lead/Presenter: Paul Heidenreich,  COIN - Palo Alto
All Authors: Heidenreich PA (MedSafe QUERI, VA Palo Alto), Sahay A (MedSafe QUERI, VA Palo Alto HCS), Lin S (MedSafe QUERI, VA Palo Alto HCS) Parizo J (MedSafe QUERI, VA Palo Alto HCS)

Objectives:
Concern has been raised in non-VA US health care that large financial penalties for high readmission rates (from the Hospital Readmission Reduction Program) has led to reduced 30-day readmissions at the expense of increased 30-day mortality. While the VA does not financially penalize hospitals for high readmission rates, both readmission and mortality impact Strategic Analytics for Improvement and Learning (SAIL) metrics that are used to judge VA facility quality. We sought to determine if the decreasing readmission, increasing mortality trend was observed in the VA as well.

Methods:
We examined trends in 30 day-mortality and 30-day all-cause readmission (to VA facilities) for patients hospitalized with heart failure (based on principal discharge diagnosis) for 3 time periods (2007-2008, 2011-2012, and 2015-2017). We adjusted 30-day mortality and readmission for patient demographics, co-morbid diagnoses in the prior two years, prior hospitalization, left ventricular ejection fraction (from natural language processing), laboratory data, and vital signs on admission.

Results:
Over time, mean age increased slightly from 71.0 (2007-2008) to 71.4 years (2015-2017). The unadjusted 30-day readmission rate was 16.9% in 2007-2008, 17.1% in 2011-2012 and 15.5% in 2015-2017. Unadjusted 30-day mortality was 8.9% in 2007-2008, 8.0% in 2011-2012, and 6.7% in 2015-2107. After adjustment, the odds ratios for 30-day readmission (vs. 2007-2008) were 0.95 (95% CI, 0.91-1.0) in 2011-2012 and 0.85 (95% CI, 0.81-0.89) in 2015-2017. The adjusted odds ratio for 30-day mortality (vs. 2007-2008) was 1.01 (95% CI, 0.95-1.07) in 2011-2012 and 0.88 (95% CI, 0.82-0.93) in 2015-1017.

Implications:
Unlike in the Medicare program, both 30-day readmission and mortality have decreased in recent years following a VA heart failure hospitalization.

Impacts:
These data should ease concerns for a harmful effect of including the heart failure readmission rate as part of performance evaluation (SAIL) for VA facilities.