Wadhera RK, et al. - Investigators analyzed how the Hospital Readmissions Reduction Program (HRRP) correlated with mortality among Medicare recipients hospitalized for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. They observed a prominent association of HRRP with an increase in 30-day postdischarge mortality following hospitalization for HF and pneumonia, but not AMI.

Methods

• In this retrospective cohort study, hospitalizations for HF, AMI, and pneumonia among Medicare fee-for-service beneficiaries aged 65 years or more were analyzed across 4 periods from April 1, 2005, to March 31, 2015.
• Period 1 (from April 2005 to September 2007) and period 2 (from October 2007 to March 2010) occurred before the HRRP to establish baseline trends.
• Period 3 and period 4 were after HRRP announcement ie, from April 2010 to September 2012 and HRRP implementation ie, from October 2012 to March 2015.
• Main outcomes and measures included inverse probability–weighted mortality within 30 days of discharge following hospitalization for HF, AMI, and pneumonia, and stratified by if there was a related readmission.
• They considered mortality within 45 days of initial hospital admission as an additional end point for target conditions.

Results

• They included 8.3 million hospitalizations for HF, AMI, and pneumonia; 7.9 million (mean age, 79.6 [8.7] years; 53.4% women) of whom were alive at discharge in this study cohort.
• They recorded 3.2 million hospitalizations for HF, 1.8 million for AMI, and 3.0 million for pneumonia.
• They noted 270,517 deaths within 30 days of discharge for HF, 128,088 for AMI, and 246,154 for pneumonia.
• They observed an increase in 30-day postdischarge mortality before the announcement of the HRRP among subjects with HF (0.27% increase from period 1 to period 2).
• HRRP announcement (0.49% increase from period 2 to period 3; difference in change, 0.22%, P=.01) and implementation (0.52% increase from period 3 to period 4; difference in change, 0.25%, P=.001) were observed to be significantly correlated with an increase in postdischarge mortality vs the baseline trend.
• The HRRP announcement was linked with a reduction in postdischarge mortality (0.18% pre-HRRP increase vs 0.08% post-HRRP announcement decrease; difference in change, −0.26%; P=.01) and did not significantly change after HRRP implementation among individuals with AMI.
• They observed stable postdischarge mortality before HRRP (0.04% increase from period 1 to period 2) among those with pneumonia, but a significant increase after HRRP announcement (0.26% post-HRRP announcement increase; difference in change, 0.22%, P=.01) and implementation (0.44% post-HPPR implementation increase; difference in change, 0.40%, P < .001).
• They noticed an overall increase in mortality among subjects with HF and pneumonia related mainly to outcomes among people who were not readmitted but died within 30 days of discharge.
• HRRP implementation was not linked significantly to an increase in mortality within 45 days of admission, relative to pre-HRRP trends in all three of the studied conditions.