Today's quandary: Better survival, sicker patients
The retrospective cohort study published in the Annals of Internal Medicine used a population-based registry in one county in Minnesota to better understand patient- and treatment-specific factors behind rehospitalization of incident MI patients. Readmission within 30 days is considered an indicator of the quality of care.
We may want to reassess that notion. What the researchers found is that hospitals are doing a bang-up job of treating incident MIs. In-hospital survival had improved from 89 percent for a 1987 through 1992 period to 95.8 percent for 2005 through 2010.
But over that time span, the patient population had gotten more complex with multiple comorbidities. The frequency of hypertension, hyperlipidemia, diabetes, obesity, chronic obstructive pulmonary disease and anemia all had increased.
“Patients who present with a heart attack nowadays don’t look like patients who presented 20 or even 10 years ago,” said senior author Veronique L. Roger, MD, MPH, of the health sciences research department at Mayo Clinic in Rochester, Minn., in an interview with Cardiovascular Business.
Roger et al found that almost one-third—30.2 percent—of rehospitalizations were unrelated to the incident MI and 27.2 percent were unclear. This raises questions about quality metrics based on 30-day readmissions, especially if they become linked to reimbursement that rewards top performers and punishes poor performers.
Can the models appropriately risk adjust to fairly rank hospitals that treat MI patients with multiple morbidities? Risk-adjustment models in stroke recently were challenged by researchers in the Journal of the American Medical Association, but the JAMA researchers suggested MI models were adequate.
Roger and colleagues look beyond metrics with recommendations to treat the whole patient. “Our patients are getting older and sicker,” she said. “We can’t lose sight that we are treating the patients, not the disease.”
In the September issue of Cardiovascular Business, we will revisit the Roger et al study and describe evidence-based strategies for improving outcomes such as 30-day readmissions in MI and heart failure. How do measures fit into your practice management programs? Please let me know.
Cardiovascular Business, editor