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Published on: September 15, 2023
Elements of the care environment influence coronary artery bypass surgery readmission
Michael P Rogers1, Evelena Cousin-Peterson1, Tara M Barry1
1Department of Surgery, University of South Florida Morsani College of Medicine Tampa, FL, USA.
Insights
Unplanned readmissions after coronary artery bypass grafting are influenced by patient discharge and hospital factors. Hospitals with lower readmission rates have greater scale, resources, and not-for-profit status.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Healthcare Quality Improvement
Background:
- Coronary artery bypass grafting (CABG) 30-day unplanned readmissions are a key performance metric for the Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program.
- Understanding hospital infrastructure and patient clinical profiles is crucial for reducing CABG readmissions.
Purpose of the Study:
- To identify patient and hospital-level factors associated with 30-day unplanned readmissions after isolated coronary artery bypass grafting.
- To compare characteristics of hospitals with the lowest versus highest readmission rates.
Main Methods:
- Utilized a merged dataset from Healthcare Cost and Utilization Project, American Hospital Association, and Healthcare Information Management Systems Society databases across 8 states.
- Performed backwards stepwise logistic regression on isolated CABG procedures to analyze all-cause 30-day readmissions.
- Categorized 903 hospitals into quartiles based on readmission rates, comparing lowest (Q1) and highest (Q4) performing hospitals.
Main Results:
- 15.5% of 150,215 isolated CABG patients were readmitted within 30 days.
- Discharge disposition was a primary determinant of readmission.
- Patients in highest readmission quartile (Q4) were more often female, older (>70), and had Medicare.
- Low readmission hospitals (Q1) had higher costs, not-for-profit status, Joint Commission accreditation, and greater hospital scale and staffing.
Conclusions:
- Discharge disposition significantly impacts CABG readmissions, but hospital characteristics like size, staffing, and ownership are also critical.
- Reducing readmissions requires a focus beyond individual patient factors to encompass the entire care continuum.
- Readmission rates serve as a surrogate measure for overall care quality and outcomes.
Background:
Coronary artery bypass grafting 30-day unplanned readmission is a focus for the CMS Hospital Readmissions Reduction Program. Awareness of the critical elements of the care delivery environment, including hospital infrastructure and patient clinical profiles that predispose toward readmission, is essential to proactively decrease readmissions.
Methods:
The Healthcare Cost and Utilization Project-State Inpatient Database, American Hospital Association Annual Health Survey Database, and Healthcare Information Management Systems Society data sets were merged to create a single data set of patient- and hospital-level data from 8 states. Isolated coronary artery bypass grafting procedures were queried for all-cause 30-day readmission, and backwards stepwise logistic regression was performed. Readmission rate was then used to categorize hospitals into quartiles, and analysis focused on the hospitals with the lowest (Q1) and highest (Q4) readmission rates. Univariate analysis was performed comparing Q1 and Q4 hospitals.
Results:
A total of 150,215 patients underwent isolated coronary artery bypass grafting with 23,244 (15.5%) readmitted patients among 903 hospitals. Model area under the curve was 0.709 (95% confidence interval, 0.702-0.716), with the top 3 readmission determinants related to discharge disposition. Compared to Q1, Q4 patients more often were female, were > 70 years of age, and had Medicare as a primary payor (P < .001). Low readmission rate hospitals were characterized by higher costs; not-for-profit status; having Joint Commission accreditation; and higher total admissions, operative volume, hospital/ICU beds, full-time physicians, nurses, and ancillary personnel (P < .001).
Conclusion:
Readmission after coronary artery bypass grafting is strongly influenced by discharge disposition. However, hospital factors such as scale, personnel, and ownership structure are significant contributors to readmission. Focus beyond patient factors to include the entire continuum of care is required to enhance outcomes, of which readmission is one surrogate measure.
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