A systematic review and meta-analysis on the association between quality of hospital care and readmission rates in patients with heart failure

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• 作者：Claudia Fischer ; MSc^a ; ^{c.fischer@erasmusmc.nl" class="auth_mail" title="E-mail the corresponding author} ; Ewout W. Steyerberg ; PhD^a ; ^d ; ^{e.steyerberg@erasmusmc.nl" class="auth_mail" title="E-mail the corresponding author} ; Gregg C. Fonarow ; MD^b ; ^{gfonarow@mednet.ucla.edu" class="auth_mail" title="E-mail the corresponding author} ; Theodore G. Ganiats ; MD^c ; ^{tganiats@ucsd.edu" class="auth_mail" title="E-mail the corresponding author} ; Hester F. Lingsma ; PhD^a ; ^e ; ^{h.lingsma@erasmusmc.nl" class="auth_mail" title="E-mail the corresponding author}
• 刊名：American Heart Journal
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：170
• 期：5
• 页码：1005-1017.e2
• 全文大小：489 K

文摘

In recent years, readmission rates have been increasingly used as a measure of quality of hospital care for patients with heart failure. The aim of this systematic review is to assess the scientific evidence regarding the relation between hospital readmission rates and quality of hospital care for patients with heart failure.

Methods

We defined quality of hospital care for patients with heart failure by adhering to the performance measures developed by the American College of Cardiology (ACC)/American Heart Association (AHA). Relevant articles published in English and indexed in the bibliographic databases Embase, Medline OvidSP, Web of Science, Cochrane Central, and PubMed were reviewed.

Results

Of the 2,638 studies identified, 18 were included. They varied widely in their methodology, data sources used, and study populations. We found mixed but rather limited evidence that there is a relationship between the ACC/AHA process measures and the rate of readmission. Four of 10 studies showed a significant correlation of readmission rate with “angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use.” Three of 9 studies showed a significant correlation between readmission rates and “evaluation of left ventricular systolic function.” One of 7 studies showed a significant correlation with “smoking cessation counseling,” and 2 of 8 showed a significant correlation with “providing discharge instructions.” No evidence was found for a relationship between readmission rates and the performance measure “warfarin for atrial fibrillation.”

Conclusions

Readmission rates after heart failure are mostly not related to the evidence-based ACC/AHA in-hospital process indicators for heart failure. It is unclear whether in-hospital quality of care is the key determinate of the readmission rate or whether readmissions are likely influenced more by postdischarge care. Further research is needed to clarify whether the readmission rate is a reflection of hospital care or quality of care on a larger level, especially when it is used for a pay-for-performance scheme to measure quality of hospital care.