PCV82 FACTORS ASSOCIATED WITH UNPLANNED 30-DAY HEART FAILURE READMISSION RATES AMONG MEDICARE AND MEDICAID PATIENTS IN TEXAS

Abstract

The study aimed to determine an association between unplanned 30-day Heart Failure (HF) readmission rates and factors outside of hospital’s control among Medicare and Medicaid patients in Texas. We used the Texas Hospital Inpatient Research Data File (RDF) to select Medicare and Medicaid patients discharged with a principal diagnosis of heart failure (HF) during the January 1st, through December 31st, 2014. We applied an endorsed measure by the National Quality Forum (NQF) to develop analytic sample. Multi-level logistic regression analyses examined patient-level and community-level characteristics. The unplanned 30-day HF readmission rates were 20.76% in Medicare (5,392 readmission/25,978 HF admission) vs. 30.63% in Medicaid (939 readmission/3066 HF admission). Controlled for other factors, Medicaid patients were 1.51 times more likely to be readmitted within 30 days than Medicare patients. (OR: 1.51 95% CI 1.38 - 1.65, p< 0.001). Patients lived in area with higher median household income were less likely to be readmitted (OR: 0.89, 95% CI 0.83 - 0.95, p < 0.001). The odds ratios were significantly lower in counties with higher density of health professionals (Primary care physician per 100K - OR: 0.89, 95%CI 0.80 - 0.99, p=0.025, Ratio general practitioner to specialist – OR: 0.89 95%CI 0.80 - 0.99, p=0.025, Hospital bed per 100K – OR: 0.90, 95%CI 0.83 - 0.99, p=0.032). Policy makers should consider a multidisciplinary strategy to help hospitals serving higher composition of patients with lower socioeconomic status or lower access to care to achieve higher performance.