Abstract P114: Fallacy of Same-Hospital Readmission Rates

Abstract

Background: It is unknown to what extent same-hospital readmission rates for patients with heart failure (HF) or acute myocardial infarction (AMI) underestimate a more robust assessment of readmission rates for a variety of patients discharged from a large academic medical center. Methods and Results: We retrospectively identified all patients discharged after hospitalization for HF or AMI from Cleveland Clinic Main Campus, a large academic medical center which is a part of an integrated 9 hospital health system in Cuyahoga County, Ohio. We abstract 30-day all-cause readmission rates for this cohort from administrative databases of all 9 health system hospitals. We then compared same-hospital to system-wide readmission rates. Over the 17 month study span 1,187 Cuyahoga County residents had a total of 1,458 discharge episodes from Cleveland Clinic Main Campus. Of these, 886 episodes were for primary HF hospitalizations, and 572 for primary AMI hospitalizations. We found that twenty-one percent (95% confidence interval [CI]: 16-26%) of HF readmissions, and 29% (95% CI: 20-39%) of AMI readmissions were to a hospital other than the one which initially discharged the patient. Conclusions: Within our integrated multi-hospital health system located in a single county in northeast Ohio, same-hospital readmission rates for HF and AMI substantially underestimated system-wide readmission rates. Hospitals should be wary of using this biased metric to assess performance or to track quality improvement efforts.