Abstract 171: Incidence and Predictors of Recurrent 30-Day Readmissions after Hospitalization for Heart Failure, Myocardial Infarction and Pneumonia

Background and Purpose: Thirty-day readmission rate is an indicator of quality and efficiency of care. Patients admitted within 30 days after index hospitalization are at high risk for recurrent 30-day readmissions. Therefore, we aimed to study the incidence and predictors of recurrent 30-day readmission after hospitalization for heart failure (HF), myocardial infarction (MI) and pneumonia. Methods: California State Inpatient Database (SID), a discharge database of all acute care admissions in the state of California was analyzed for adults discharged alive during 2003 to 2011 with primary diagnosis of HF, MI, or pneumonia using ICD-9 codes as defined by CMS for public reporting. Index cases were followed up for all-cause recurrent 30-day readmission using revisit variables included in SID. Inter-hospital transfers were counted as one common admission. Each patient could provide more than one index admissions if admitted multiple times with diagnosis of HF, MI or pneumonia during the study period. Multiple logistic regression models were constructed to identify independent factors associated with recurrent 30-day readmissions. Results: Of the 741,318 cases of HF, 374,860 cases of MI, and 676,412 cases of pneumonia included in the analysis, 70,629 (9.5%), 18,314 (4.9%) and 36,254 (5.4%) resulted in recurrent 30-day readmissions respectively. Rates of recurrent 30-day readmission after initial 30-day readmissions were 36.4%, 25.5%, and 29.4% for HF, MI and pneumonia respectively. Among 30-day readmissions, 66.6%, 69.0% and 66.5% were readmitted again within first 15 days of discharge from the initial 30-day readmission respectively. The most common etiology for recurrent 30-day readmission after HF and MI was HF (37.5% and 17.6% respectively), and after pneumonia was pneumonia (14.1%). In multivariate analysis, recurrent 30-day readmission rate was higher among younger, non-white race, Medicaid and Medicare (vs. private insurance), higher comorbidity index, hospitals with lowest case volume, and discharge against medical advice, discharge to facility or home health care (vs. home/self-care). Conclusion: Patients admitted within 30 days from discharge remains at high risk for recurrent 30-day readmission. Two-thirds of readmissions occurred within 15 days of discharge from the previous admission thus, interventions implemented before the discharge and during early post-discharge follow up are keys to successfully reducing recurrent 30-day readmissions. </jats:p