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Acute Myocardial Infarction Rehospitalization of the Medicare Fee-for-Service Patient: A State-Level Analysis Exploring 30-Day Readmission Factors.
Prof Case Manag. 2013 November/December;18(6):295-302
Authors: Schmeida M, Savrin R
Abstract
PURPOSE OF THE STUDY:: Acute myocardial infarction (AMI) readmission among the older adults is frequent and costly to the Medicare Trust Fund and to the patient in preventable suffering. In this study, we explore factors that are associated with states having AMI readmission rates that are higher than the U.S. national rate.
PRIMARY PRACTICE SETTING(S):: Acute inpatient hospital settings.
METHODOLOGY AND SAMPLE:: Multivariate regression analysis of 50 state-level data is used. The dependent variable AMI 30-day readmission worse than U.S. rate is based on adult Medicare fee-for-service patients hospitalized with a primary discharge diagnosis of AMI and for which a subsequent all-cause readmission occurred within 30 days of their last discharge.
RESULTS:: We find one key variable-states with more β-blocker prescription given at discharge-that is significantly associated with a decrease in probability in states ranking "worse" on AMI 30-day readmission. Whereas, states with more total days of care per 1,000 Medicare enrollees, more community hospital outpatient visits per 1,000 population, and greater aspirin prescription given at discharge have a greater probability for AMI 30-day readmission to be "worse" than the U.S. national rate.
IMPLICATIONS FOR CASE MANAGEMENT PRACTICE:: Case management programs targeting efficient medication reconciliation from the hospital setting to the transfer setting can potentially help minimize readmission for patients highly dependent on β-blockers for improved clinical outcomes. This intervention may be more effective than other factors to improve state-level hospital status on AMI 30-day readmission. Factors such as total days of care per 1,000 Medicare enrollees, more community hospital outpatient visits per 1,000 populations, and greater aspirin prescription given at discharge may not be as important as β-blocker prescription given at discharge.
PMID: 24100532 [PubMed - as supplied by publisher]