Author + information
- Liliya Benchetrita,b,
- Chloe O. Zimmermana,b,
- Haikun Baoa,b,
- Kumar Dharmarajana,b,
- Faseeha Atlafa,b,
- Jeph Herrina,b,
- Zhenqiu Lina,b,
- Harlan Krumholza,b,
- Elizabeth Dryea,b,
- Kasia Lipskaa,b and
- Erica Spatza,b
Background: Admissions among ambulatory patients with heart failure (HF) is a key quality metric for Accountable Care Organizations (ACOs). Yet HF patients are at risk for many acute illnesses, HF and non-HF related, and it is unknown whether specific types of admissions explain lower or higher ACO admission rates.
Methods: We examined admission types among 220 Medicare Shared Savings Program ACOs in 2013, stratified by their performance on a measure of unplanned risk-standardized acute admission rates (RSAARs) among HF patients. ACOs were stratified into quartiles (Q1 and Q4 indicating ACOs with lowest and highest RSAARs, respectively). Based on a previously validated algorithm, we categorized admissions by principal discharge diagnosis into: HF, Non-HF/cardiovascular (CV), and Non-CV. We compared the mean proportional admission rates across quartiles, weighted by ACO size.
Results: There were 169,383 acute, unplanned admissions among 227, 356 HF patients. The median (IQR) RSAARs per 100 person-years for ACOs in Q1 and Q4 were 64.5 (61.7-67.7) and 94.0 (90.1-99.9), respectively. ACOs in Q1 had fewer non-CV admissions as compared to ACOs in Q4 (p<0.0001)
Conclusions: Over two-thirds of admissions among ambulatory ACO patients with HF were for non-CV causes. ACOs with lower RSAARs had slightly fewer admissions for non-CV causes, suggesting that ACOs with good performance on a HF quality measure may achieve their status by preventing various types of acute illnesses for which HF patients are at risk.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Heart Failure: Evaluating Strategies to Prevent Readmissions
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1163-254
- 2017 American College of Cardiology Foundation