Index hospitalization predictors of subsequent readmission for acute myocardial infarction, heart failure, and pneumonia in North Carolina Medicare enrollees

The Hospital Readmissions Reduction Program (HRRP), established by Section 3025 of the Affordable Care Act, seeks to reduce healthcare expenditures and improve healthcare quality by creating an impetus for hospitals to reduce the rates of costly re-admissions by linking these events to the revenue stream. HRRP requires the Centers for Medicare and Medicaid Services (CMS) to reduce inpatient prospective payments to hospitals which exceed the three-year national average for re-admission for the conditions of acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). We seek to understand index hospitalization predictors of subsequent re-admission so that targeted interventions and better discharge planning can be developed for this important patient population. Utilizing the 2010 Healthcare Cost and Utilization Project database for North Carolina, which contains the universe of hospital discharge records for the year, we examine which patient and hospitalization characteristics (length of stay, admission type, procedure utilization, discharge status, comorbidities, and demographics) are at increased odds of patient re-admission within 30-days of the index hospitalization event. We use separate logistic regressions to compare patient and hospital characteristics associated with AMI, HF and PN between patients with and without a re-admission event. Reflecting the literature on re-admission for these conditions, our analyses are further stratified by hospital size and region. We propose that these findings will support discharge planning for patients with AMI, HF, and PN and assist hospitals in their efforts to preserve levels of CMS inpatient prospective payments.