Heart failure patients admitted by geriatricians less likely to experience readmission: 7 study findings to know

Readmission rates for Medicare penalty diagnoses of congestive heart failure, chronic obstructive pulmonary disease and pneumonia vary by physician, suggests a study published by the American Journal of Managed Care.

For the study, researchers examined 30-day readmissions at Cambridge, Mass.-based Mount Auburn Hospital between Jan. 1, 2013, and Dec. 31, 2015. Researchers assessed for the type of attending physician, diagnosis, payer, patient demographics, discharge disposition and clinical factors such as primary diagnoses and length of stay. Additionally, researchers conducted interviews with both patients who experienced readmissions and patients who did not.

Here are seven study findings.

1. Overall, 17,099 patients were admitted for CHF, COPD and pneumonia during the study period. All three diagnoses are considered Medicare penalty diagnoses under the ACA's Hospital Readmissions Reduction Program, meaning hospitals can be penalized if they have too many readmissions for these conditions.

2. Among those admitted for these conditions, 2,226 experienced a 30-day readmission, according to the study. That's a total 13 percent readmission rate.

3. The study found patients who were divorced or legally separated (15.7 percent) and widowed (15.7 percent) had a higher chance of being readmitted than married patients (11.6 percent).

4. Researchers said being Asian/Pacific Islander (7.1 percent) or "other" race (6.8 percent) and having private insurance (8.3 percent) were also linked to lower readmissions.

5. Additionally, the study found readmissions varied by attending type. The readmission rates for CHF, COPD, and pneumonia by attending type were:

  • Geriatricians — 11 percent
  • Hospitalists — 13.7 percent 
  • Cardiologists — 18.5 percent
  • Intensivists — 17.4 percent
  • Primary care physicians — 16.7 percent

6. Interviews revealed readmitted patients were more likely than their nonreadmitted counterparts to not have an outpatient connection to a primary care provider (10.7 percent compared to 0 percent), to not be able to complete daily living activities on their own (32.1 percent compared to 11.1 percent), and to not have support of family members during their inpatient stay (17.9 compared to 10.7 percent).

7. The study's authors concluded: "This study found a lower readmission rate for those with CHF, COPD, and pneumonia who were admitted by geriatricians, supporting the notion that enhanced care coordination lowers readmissions. Patient with lower social connectedness were more likely to be readmitted. These findings support the value of rigorous identification of individual risk factors for readmission and of tailoring discharge planning."

 

More articles on healthcare quality: 
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