Impact of Hyperglycemia on 30-Day Readmission Rates

Abstract

Background: The Centers for Medicare and Medicaid (CMS) Hospital Readmissions Reduction Program (HRRP) aims to reduce 30-day readmission rates for patients with acute myocardial infarction, heart failure, pneumonia, chronic obstructive pulmonary disease and hip/knee arthroplasty. The impact of hyperglycemia on readmission rates for these diagnoses is not known. Methods: We analyzed 30-day readmission rates for patients discharged from Florida Hospital Orlando with CMS HRRP diagnoses from July 1, 2014 through June 30, 2017. Subjects were grouped according to eligibility (2 point-of-care glucoses within 24 hours) for our glycemic monitoring program (GMP) or not (non-GMP). The GMP group was further divided into controlled (C-GMP, mean blood glucose during hospitalization 70-180 mg/dL) and hyperglycemic (H-GMP, mean blood glucose > 180 mg/dL) groups. Results: The GMP group had significantly higher readmission rates than the non-GMP group, as did the H-GMP group relative to the C-GMP group (Table). These differences remained significant after adjusting for difference in age, sex, diagnosis, case mix index and other factors in logistic regression analyses. Conclusion: Hyperglycemic patients discharged with a CMS HRRP diagnosis have higher 30-day readmission rates. Strategies to prevent readmission should target glycemic control during and after hospitalization.VariableNon-GMPGMPC-GMPH-GMPN1767517008111205888Female %53.9%49.8%49.7%49.9%White %78.5%71.8%71.0%73.3%Age (years)67686967Weight (kg)80.28885.592.7Case Mix Index1.492.072.311.6130-Day Readmission Rate (%)14.421.5**21.122.3* * P < 0.05, ** P < 0.01 in risk-adjusted logistic regression analyses. Disclosure M. Gaines: None. R.E. Pratley: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Pfizer Inc., Sanofi-Aventis, Takeda Development Center Americas, Inc..