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The association of hospital teaching intensity with 30‐day postdischarge heart failure readmission and mortality rates
Author(s) -
Shahian David M.,
Liu Xiu,
Mort Elizabeth A.,
Normand SharonLise T.
Publication year - 2020
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13248
Subject(s) - medicine , decile , emergency medicine , logistic regression , mortality rate , hospital readmission , demography , statistics , mathematics , sociology
Objective To investigate risk‐adjusted, 30‐day postdischarge heart failure mortality and readmission rates stratified by hospital teaching intensity. Data Sources and Study Setting A total of 709 221 Medicare fee‐for‐service beneficiaries discharged from 3135 US hospitals between 1/1/2013 and 11/30/2014 with a principal diagnosis of heart failure. Study Design Hospitals were classified as Council of Teaching Hospitals and Health Systems (COTH) major teaching hospitals, non‐COTH teaching hospitals, and nonteaching hospitals. Hospital teaching status was linked with MedPAR patient data and FY2016 Hospital Readmission Reduction Program penalties. Index hospitalization survival probabilities were estimated with hierarchical logistic regression and used to stratify index hospitalization survivors into severity deciles. Decile‐specific models were estimated for 30‐day postdischarge readmission and mortality. Thirty‐day postdischarge outcomes were estimated by teaching intensity and penalty categories. Principal Findings Averaged across deciles, adjusted 30‐day COTH hospital readmission rates were, on a relative scale ([COTH minus nonteaching] ÷ nonteaching), 1.63 percent higher (95% CI: 0.89 percent, 2.25 percent) than at nonteaching hospitals, but their average adjusted 30‐day postdischarge mortality rates were 11.55 percent lower (95% CI: −13.78 percent, −9.37 percent). Penalized COTH hospitals had the highest readmission rates of all categories (23.99 percent [95% CI: 23.50 percent, 24.49 percent]) but the lowest 30‐day postdischarge mortality (8.30 percent [95% CI: 7.99 percent, 8.57 percent] vs 9.84 percent [95% CI: 9.69 percent, 9.99 percent] for nonpenalized, nonteaching hospitals). Conclusions Heart failure readmission penalties disproportionately impact major teaching hospitals and inadequately credit their better postdischarge survival.