Clinical Preventability of 30‐Day Readmission After Percutaneous Coronary Intervention

Autor: Robert W. Yeh, Sharon-Lise T. Normand, Laura Mauri, Kevin F. Kennedy, Jason H. Wasfy, Adrian H. Zai, Neil J. Wimmer, Stephen W. Waldo, John A. Spertus, Jennifer Luttrell, Cashel O’Brien, Jordan B. Strom
Rok vydání: 2014
Předmět:
Male
Pediatrics
medicine.medical_specialty
Time Factors
Databases
Factual
Cost-Benefit Analysis
medicine.medical_treatment
Coronary Disease
Coronary Angiography
Medicare
Logistic regression
Patient Readmission
Risk Assessment
Outcomes Research
Cohort Studies
Percutaneous Coronary Intervention
Sex Factors
medicine
Hospital discharge
Performance Metrics
Humans
General hospital
Original Research
Aged
Aged
80 and over
Observer Variation
business.industry
Medical record
Age Factors
Percutaneous coronary intervention
Health Care Costs
Middle Aged
medicine.disease
Quality Improvement
Survival Analysis
Patient Discharge
United States
Primary Prevention
Heart failure
Conventional PCI
Emergency medicine
Female
Outcomes research
Cardiology and Cardiovascular Medicine
business
Readmission
Health Services and Outcomes Research
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.114.001290
Popis: Background Early readmission after PCI is an important contributor to healthcare expenditures and a target for performance measurement. The extent to which 30‐day readmissions after PCI are preventable is unknown yet essential to minimizing their occurrence. Methods and Results PCI patients readmitted to hospital at which PCI was performed within 30 days of discharge at the Massachusetts General Hospital and Brigham and Women's Hospital were identified, and their medical records were independently reviewed by 2 physicians. Each reviewer used an ordinal scale (0, not; 1, possibly; 2, probably; and 3, definitely preventable) to rate clinical preventability, and a total sum score ≥2 was considered preventable. Characteristics of preventable and unpreventable readmissions were compared, and predictors of clinical preventability were assessed by using multivariate logistic regression. Of 9288 PCI s performed, 9081 (97.8%) patients survived to initial hospital discharge and 1007 (11.1%) were readmitted to the index hospital within 30 days. After excluding repeat readmissions, 893 readmissions were reviewed. Fair agreement between physician reviewers was observed (weighted κ statistic 0.44 [95% CI 0.39 to 0.49]). After aggregation of scores, 380 (42.6%) readmissions were deemed preventable and 513 (57.4%) were deemed not preventable. Common causes of preventable readmissions included staged PCI without new symptoms (14.7%), vascular/bleeding complications of PCI (10.0%), and congestive heart failure (9.7%). Conclusions Nearly half of 30‐day readmissions after PCI may have been prevented by changes in clinical decision‐making. Focusing on these readmissions may reduce readmission rates.
Databáze: OpenAIRE
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