ACC.16: Strategies may help hospitals reduce readmissions following PCI

CHICAGO – A large mixed methods study identified several strategies that hospitals employed that were independently associated with lower risk-standardized 30-day readmission rates following PCI.

The strategies included having cardiology leaders review National Cardiovascular Disease Registry (NCDR) CathPCI registry data; retaining high quality staff; rapidly adoption new technologies used for PCI; regularly meeting with cardiac rehabilitation to review the care of cardiac patients; and arranging the date and time of a follow-up appointment when discharging patients.

Karl E. Minges, MPH, of Yale University’s School of Medicine, presented the results in a poster session at the ACC scientific session on April 4. He analyzed data from the TOP-PCI (Translating Outstanding Performance in Percutaneous Coronary Intervention) study.

Each year, there are approximately one million PCI procedures performed each year. Of those, approximately 10 percent of patients are re-admitted to the hospital within 30 days of discharge. However, risk-standardized readmission rates vary substantially across hospitals.

In 2013, the ACC and Centers for Medicare & Medicaid Services instituted voluntary public reporting of all-cause 30-day readmission measures. Minges said PCI outcomes might be included in value-based purchasing programs, as well.

The researchers conducted qualitative interviews with more than 200 clinical and ancillary staff at 13 high- and low-performing PCI hospitals based on their ranking for readmission rates. They then identified applicable survey items.

The Web-based survey was hosted on a secured server and included 75 closed-ended questions and one open-ended question pertaining to quality improvement processes. Participating hospitals received a password-protected login to work on the survey.

The researchers randomly selected 503 hospitals that participated in the NCDR CathPCI Registry. Of the 495 hospitals that met eligibility criteria, 398 completed the survey. For the statistical analysis, researchers linked clinical data from the NCDR CathPCI Registry with administrative data from Medicare Part A.

Minges said that 15.8 percent of hospitals that enrolled and 21.6 percent of hospitals that did not enroll were for-profit hospitals. In addition, hospitals with a greater number of beds had a higher response rate.

He added that 65.8 percent of hospitals had leaders review NCDR CathPCI registry data; 64.8 percent endorsed retaining high quality staff; and 75.1 percent rapidly adopted new technologies used for PCI.

“Taking together, these first three [strategies] would suggest that hospitals that have committed leadership, that are willing to invest in their employees as well as those that are willing to be on the cutting edge of innovation may have lower [risk-standardized 30-day readmission rates],” Minges said.

Further, 44.0 percent regularly met with cardiac rehabilitation to review the care of cardiac patients; and 58.3 percent arranged the date and time of a follow-up appointment when discharging patients.

“These two strategies taken together would suggest that hospitals that invest in regular meetings with individuals outside of a hospital as well as employing strategies to have quick follow-up for patients helps to actually reduce readmission rates and perhaps ease the care transition,” Minges said.

Minges said that most hospitals that participated in this study employed three or four of these strategies. There was an approximate 1 percent absolute difference in standardized readmission rates between hospitals that employed no strategies and those that employed five strategies.

“That might not seem like quite a lot,” Minges said. “But if you’re a hospital that’s on the cusp of your readmission rates for other things such as [coronary heart disease], this actually might help to reduce your overall readmission rate through the hospital readmission reduction program.”