Model for Readmissions Says Most Risk Comes Before Procedure
Results from a three-year study published in Circulation: Cardiovascular Quality and Outcomes show that most of the risk for readmissions following percutaneous coronary interventions comes into play before the procedure is performed.
Researchers at Boston's Massachusetts General Hospital created two models for predicting readmissions, one of which incorporated variables known at admission and the other incorporating variables known at discharge. The model predicting from admission variables was more accurate, though adding post-procedure variables created a modest increase in prediction accuracy.
When researchers added procedural factors to the model equations, statistical predictions for readmission risk did not change significantly.
Among the factors the study found were significant in predicting 30-day readmission rates for PCIs were age, female sex, Medicare or State insurance, congestive heart failure and chronic kidney disease. Significant post-procedural factors for readmission included no beta blocker prescription at discharge, vascular or bleeding complications and an extended hospital stay.
The models set a precedent for reducing readmissions by accurately identifying high-risk patients ahead of the introduction of the introduction of PCI as a target under the Patient Protection and Affordable Care act in 2015.
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