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30-Day Postdischarge Mortality Up With HRRP Implementation

THURSDAY, Dec. 27, 2018 -- Announcement and implementation of the Hospital Readmissions Reduction Program (HRRP) were associated with increased 30-day postdischarge mortality following hospitalization for heart failure and pneumonia, but not acute myocardial infarction (AMI), according to a study published in the Dec. 25 issue of the Journal of the American Medical Association.

Rishi K. Wadhera, M.D., from Harvard Medical School in Boston, and colleagues examined trends in patient mortality for fee-for-service hospitalizations of Medicare beneficiaries before HRRP (April 2005 to September 2007 [period 1] and October 2007 to March 2010 [period 2]), after the HRRP announcement (April 2010 to September 2012 [period 3]), and after HRRP implementation (October 2012 to March 2015 [period 4]).

The researchers found an increase in 30-day postdischarge mortality among patients with heart failure before the HRRP announcement (0.27 percent increase from period 1 to period 2); HRRP announcement and implementation correlated with significant increases in postdischarge mortality (0.49 percent increase from period 2 to period 3; 0.52 percent increase from period 3 to period 4). Among patients with AMI, a decline in postdischarge mortality was seen in association with the HRRP announcement (0.18 percent pre-HRRP increase versus 0.08 percent post-HRRP announcement decrease); there was no significant change after HRRP implementation. For pneumonia, postdischarge mortality was stable from period 1 to period 2 and increased significantly after HRRP announcement and implementation (0.26 percent increase and 0.44 percent increase, respectively).

"Further research is needed to understand whether the increase in 30-day postdischarge mortality is a result of the HRRP," the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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Posted: December 2018

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