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. 2023 Jul;16(7):e009573.
doi: 10.1161/CIRCOUTCOMES.122.009573. Epub 2023 Jul 18.

Relationship Between In-Hospital Adverse Events and Hospital Performance on 30-Day All-cause Mortality and Readmission for Patients With Heart Failure

Yun Wang  1   2 , Noel Eldridge  3   4 , Mark L Metersky  5 , David Rodrick  3 , Sheila Eckenrode  1 , Jasie Mathew  1 , Deron H Galusha  6 , Andrea A Peterson  7   8 , David Hunt  9 , Sharon-Lise T Normand  10   11 , Harlan M Krumholz  1   2   12
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Relationship Between In-Hospital Adverse Events and Hospital Performance on 30-Day All-cause Mortality and Readmission for Patients With Heart Failure

Yun Wang et al. Circ Cardiovasc Qual Outcomes. 2023 Jul.

Abstract

Background: Hospitals with high mortality and readmission rates for patients with heart failure (HF) might also perform poorly in other quality concepts. We sought to evaluate the association between hospital performance on mortality and readmission with hospital performance rates of safety adverse events.

Methods: This cross-sectional study linked the 2009 to 2019 patient-level adverse events data from the Medicare Patient Safety Monitoring System, a randomly selected medical records-abstracted patient safety database, to the 2005 to 2016 hospital-level HF-specific 30-day all-cause mortality and readmissions data from the United States Centers for Medicare & Medicaid Services. Hospitals were classified to one of 3 performance categories based on their risk-standardized 30-day all-cause mortality and readmission rates: better (both in <25th percentile), worse (both >75th percentile), and average (otherwise). Our main outcome was the occurrence (yes/no) of one or more adverse events during hospitalization. A mixed-effect model was fit to assess the relationship between a patient's risk of having adverse events and hospital performance categories, adjusted for patient and hospital characteristics.

Results: The study included 39 597 patients with HF from 3108 hospitals, of which 252 hospitals (8.1%) and 215 (6.9%) were in the better and worse categories, respectively. The rate of patients with one or more adverse events during a hospitalization was 12.5% (95% CI, 12.1-12.8). Compared with patients admitted to better hospitals, patients admitted to worse hospitals had a higher risk of one or more hospital-acquired adverse events (adjusted risk ratio, 1.24 [95% CI, 1.06-1.44]).

Conclusions: Patients admitted with HF to hospitals with high 30-day all-cause mortality and readmission rates had a higher risk of in-hospital adverse events. There may be common quality issues among these 3 measure concepts in these hospitals that produce poor performance for patients with HF.

Keywords: heart failure; hospitalization; mortality rate; readmission rates.

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Conflict of interest statement

Disclosures In the past 3 years, Harlan Krumholz received expenses and/or personal fees from UnitedHealth, Element Science, Eyedentifeye, and F-Prime. He is a co-founder of Refactor Health and HugoHealth, and is associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare & Medicaid Services and through Yale University from the Food and Drug Administration, Johnson & Johnson, Google, and Pfizer. Dr Normand, S. Eckenrode, and J. Mathew work under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures outside this submitted work. Dr Wang had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He is the founder of Boston Deep Data LLC. Dr Metersky has worked on various quality improvement and patient safety projects with the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality. His employer has received remuneration for this work. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Distributions of hospital-specific risk-standardized 30-day mortality and readmissions.
Figure 2.
Figure 2.
Distributions of hospital performance categories over time. Hospital performance was measured by its mortality and readmission rates; better: both mortality and readmission rates <25th percentile of national average; worse: both mortality and readmission rates >75th percentile of national average; and average all others.
Figure 3.
Figure 3.
Hospital characteristics by hospital performance category. Hospital performance was measured by its mortality and readmission rates; better: both mortality and readmission rates <25th percentile of national average; worse: both mortality and readmission rates >75th percentile of national average; and average all others. *The better group represents 2493 hospitals; The worse group represents 1909 hospitals; and the average group represents 35 195 hospitals. CABG indicates coronary artery bypass graft surgery; CATH, cardiac catheterization; PCI, percutaneous coronary intervention; and TJC, the Joint Commission.
Figure 4.
Figure 4.
Association between hospital performance and the risk of developing in-hospital adverse events for patients aged >18 years and aged >65 years. Hospital performance was measured by mortality and readmission rates; better: both mortality and readmission rates <25th percentile of national average; worse: both mortality and readmission rates >75th percentile of national average; and average all others.
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