Determining 30-day readmission risk for heart failure patients: the Readmission After Heart Failure scale

International Journal of General Medicine Dovepress open access to scientific and medical research ORIGINAL RESEARCH International Journal of General Medicine downloaded from https://www.dovepress.com/ by 5.20.206.45 on 03-Jul-2020 For personal use only. Open Access Full Text Article Determining 30-day readmission risk for heart failure patients: the Readmission After Heart Failure scale This article was published in the following Dove Press journal: International Journal of General Medicine Ronald S Chamberlain 1–5 Jaswinder Sond 1 Krishnaraj Mahendraraj 1 Christine SM Lau 1,3 Brianna L Siracuse 1 1 Department of Surgery, Saint Barnabas Medical Center, Livingston, 2 Department of Surgery, Rutgers New Jersey Medical School, Rutgers University, Newark, NJ, USA; 3St. George’s University School of Medicine, Grenada, West Indies; 4 Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA; 5Department of Surgery, Valley Cancer Surgical Specialists, Phoenix, AZ, USA Background: Chronic heart failure (CHF), which affects >5 million Americans, accounts for >1 million hospitalizations annually. As a part of the Hospital Readmission Reduction Program, the Affordable Care Act requires that the Centers for Medicare and Medicaid Services reduce payments to hospitals with excess readmissions. This study sought to develop a scale that reliably predicts readmission rates among patients with CHF. Methods: The State Inpatient Database (2006–2011) was utilized, and discharge data including demographic and clinical characteristics on 642,448 patients with CHF from California and New York (derivation cohort) and 365,359 patients with CHF from Florida and Washington (validation cohort) were extracted. The Readmission After Heart Failure (RAHF) scale was developed to predict readmission risk. Results: The 30-day readmission rates were 9.42 and 9.17% (derivation and validation cohorts, respectively). Age <65 years, male gender, first income quartile, African American race, race other than African American or Caucasian, Medicare, Medicaid, self-pay/no insurance, drug abuse, renal failure, chronic pulmonary disorder, diabetes, depression, and fluid and electrolyte disorder were associated with higher readmission risk after hospitalization for CHF. The RAHF scale was created and explained the 95% of readmission variability within the validation cohort. The RAHF scale was then used to define the following three levels of risk for readmission: low (RAHF score <12; 7.58% readmission rate), moderate (RAHF score 12–15; 9.78% readmission rate), and high (RAHF score >15; 12.04% readmission rate). The relative risk of readmission was 1.67 for the high-risk group compared with the low-risk group. Conclusion: The RAHF scale reliably predicts a patient’s 30-day CHF readmission risk based on demographic and clinical factors present upon initial admission. By risk-stratifying patients, using models such as the RAHF scale, strategies tailored to each patient can be implemented to improve patient outcomes and reduce health care costs. Keywords: heart failure, readmission, risk factors, risk assessment, RAHF scale, hospital readmission reduction program, HRRP, SID database Introduction Correspondence: Ronald S Chamberlain Department of Surgery, Valley Cancer Surgical Specialists, 16601 N. 40th Street, Suite 204 Phoenix, AZ 85032, USA Tel +1 602 996 4747 Fax +1 602 953 5466 Email 127 submit your manuscript | www.dovepress.com International Journal of General Medicine 2018:11 127–141 Dovepress © 2018 Chamberlain et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/IJGM.S150676 Powered by TCPDF (www.tcpdf.org) Chronic heart failure (CHF) is the most common cause of readmission for Medicare patients in the USA. The Heart Disease and Stroke Statistics Report (2016) from the American Heart Association estimated that the prevalence of heart failure is ~5.7 million, and an estimated 1 million hospital stays were attributable to CHF.1 The discharge rate for patients with CHF increased from 400,000 in 1979 to 1,084,000 in 2005.2 As of 2010, hospitalization rates remained consistently >1 million.1 In 2014, US health care costs accounted for 17.5% of the gross domestic product (GDP) (~$3.0 trillion) com- Dovepress International Journal of General Medicine downloaded from https://www.dovepress.com/ by 5.20.206.45 on 03-Jul-2020 For personal use only. Chamberlain et al pared to 9.18% of the GDP ($260 billion) in 1980.3 At this current rate, by 2040, the cost of health care could reach 30% of the GDP.4 In 2014, Medicare paid $173 billion on outpatient and inpatient services to 4,700 hospitals, a 4% increase from the year before.5 The American Heart Association estimates that the total direct costs (defined as medical spending) for treating CHF will rise to $53 billion in 2030, more than double the $21 billion in 2012.6 Hospital readmissions consume significant resources and are a financial burden on the US health care system. In 2005, Medicare 7-day hospital readmission rates were 6.2% and 30-day readmission rates were 17.6%. A majority of these 7- and 30-day readmissions were considered preventable (84 and 76%, respectively).7 The 15-day CHF readmission rates were 12.5%, costing ~$600 million.7 As a result of increased spending on Medicare reimbursements, the Medicare Payment Advisory Commission (MedPAC) predicted higher health care premiums and taxes.7 To address the burgeoning cost of hospital readmissions, the Affordable Care Act (ACA) was established and signed into law in March 2010 by President Barack Obama.8 The ACA created the Hospital Readmissions Reduction Program (HRRP), which required the Centers for Medicare and Medicaid Services (CMS) to penalize hospitals with high rates of readmissions by reducing hospital reimbursements effective October 2012.7,9 According to the CMS, a “readmission” was defined as an admission to a hospital within 30 days of a discharge from the same or another hospital.7 At the initiation of the HRRP in October 2012, CMS predicted that >2/3 of hospitals would be receiving fines, accounting for up to 1% of their Medicare reimbursement.9 It was also predicted that these penalties would increase to 3% by 2015, affecting 2,217 hospitals, and ~$280 million loss in Medicare funds.9 This program provided significant incentives for both health care professionals (...truncated)