MedicalResearch.com Interview with:
Christian A. McNeely, M.D.
Resident Physician – Internal Medicine
Washington University Medical Center
MedicalResearch.com: What is the background for this study?
Response: Prior research has demonstrated that readmission in the first 30 days after percutaneous coronary intervention (PCI) is common, reported around one in six or seven Medicare beneficiaries, and that many are potentially preventable. Since 2000, there have been significant changes in the management of coronary artery disease and the use of PCI. Additionally, in the last decade, readmission rates have become a major focus of research, quality improvement and a public health issue, with multiple resulting national initiatives/programs which may be affecting care. Therefore, in this study, we sought to examine contemporary trends in readmission characteristics and associated outcomes of patients who underwent PCI using the Medicare database from 2000-2012.
MedicalResearch.com: What are the main findings?
Response: We found that from 2000-2012, readmission rates declined from 16.1%to 15.4%, with the decline becoming more marked after 2010. When adjusted for the increasing comorbidities observed over time, this translated to a 33% lower likelihood of readmission after PCI in 2012 compared to 2000.
The majority of readmissions were for cardiovascular-related conditions (>60%), however only small percentage (<8%) of total readmissions were for acute MI, unstable angina, or cardiac arrest/cardiogenic shock. A much larger percentage of patients were readmitted with chest pain/angina (7.9%), chronic ischemic heart disease (26.6%), and heart failure (12%).
MedicalResearch.com: What should readers take away from your report?
Response: Since 2000, there have been significant declines in readmission after PCI in the Medicare population, with particularly marked improvements after 2010, despite patients presenting with more comorbidities. With administrative data, it is difficult to determine the factors explaining this decline, however, a variety of changes have occurred in PCI, as well as the healthcare system in general, within last decade, which may be impacting behavior, such as public reporting of readmission data, the Hospital Readmissions Reduction Program, and changes in PCI techniques. Furthermore, the majority of readmissions are not for acute coronary syndromes or procedural complications, suggesting that many of these patients may be relatively low risk for major cardiac events. This sends a signal a large proportion of readmissions remain which are potentially avoidable or at least triaged into less resource intensive units of the hospital.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We believe that there is still substantial room to improve the post-discharge outcomes of patients after PCI and with cardiovascular disease in general. We have learned a tremendous amount about risk factors for readmission. We need to be able to identify patients at high-risk for readmission while in the hospital and target them with preventative strategies at discharge.
In order to determine policies which can be instituted nationally, healthcare systems must to study various initiatives aimed at improving readmission and post-discharge outcomes in prospective trials. Furthermore, national and state-wide funds need to be available to support this work.
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Readmission after inpatient percutaneous coronary intervention in the Medicare population from 2000 to 2012
McNeely, Christian et al.
American Heart Journal , Volume 179 , 195 – 203
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