Hospital Performance in Acute Myocardial Infarction

Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission

Harlan M. Krumholz, MD, SM; Angela R. Merrill, PhD; Eric M. Schone, PhD; Geoffrey C. Schreiner, BS;Jersey Chen, MD, MPH; Elizabeth H. Bradley, PhD; Yun Wang, PhD; Yongfei Wang, MS; Zhenqiu Lin, PhD;Barry M. Straube, MD; Michael T. Rapp, MD, JD; Sharon-Lise T. Normand, PhD and Elizabeth E. Drye, MD, SM

From the Section of Cardiovascular Medicine (H.M.K., G.C.S., J.C., Y.W., Y.-F.W., E.E.D.) and the Robert Wood Johnson Clinical Scholars Program (H.M.K.), Department of Internal Medicine; Section of Health Policy and Administration (H.M.K., E.H.B.), School of Public Health, Yale University School of Medicine; and the Center for Outcomes Research and Evaluation (H.M.K., Y.W., Z.L.), Yale-New Haven Hospital, New Haven, Conn; Mathematica Policy Research, Inc (A.R.M., E.M.S.), Cambridge, Mass; Centers for Medicare & Medicaid Services (B.M.S., M.T.R.), Baltimore, Md; and the Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health (S.-L.T.N.), Boston, Mass.

Correspondence to Harlan Krumholz, MD, Yale University School of Medicine, 1 Church St, Suite 200, New Haven, CT 06510. E-mailharlan.krumholz@yale.edu

Background: In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures.

Methods and Results: We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008. We compared weighted risk-standardized mortality and readmission rates across Hospital Referral Regions and hospital structural characteristics. The median 30-day mortality rate was 16.6% for AMI (range, 10.9% to 24.9%; 25th to 75th percentile, 15.8% to 17.4%; 10th to 90th percentile, 14.7% to 18.4%) and 11.1% for HF (range, 6.6% to 19.8%; 25th to 75th percentile, 10.3% to 12.0%; 10th to 90th percentile, 9.4% to 13.1%). The median 30-day readmission rate was 19.9% for AMI (range, 15.3% to 29.4%; 25th to 75th percentile, 19.5% to 20.4%; 10th to 90th percentile, 18.8% to 21.1%) and 24.4% for HF (range, 15.9% to 34.4%; 25th to 75th percentile, 23.4% to 25.6%; 10th to 90th percentile, 22.3% to 27.0%). We observed geographic differences in performance across the country. Although there were some differences in average performance by hospital characteristics,there were high and low hospital performers among all types of hospitals.

Conclusions: In a recent 3-year period, 30-day risk-standardized mortality rates for AMI and HF varied among hospitals and across the country. The readmission rates were particularly high.