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Risk-Standardized Mortality Rates Not Associated with Risk-Standard Readmission Rates in AMI or Pneumonia Patients

Rates Found to Be Weakly Associated in HF Patients
February 13, 2013

Risk-standardized mortality rates (RSMR) and risk-standardized readmission rates (RSRR) were not found to be associated for acute myocardial infarction (AMI) or pneumonia patients and were only moderately associated for heart failure patients, according to a study published on Feb. 12 in the Journal of the American Medical Association.

The study looked at Medicare fee-for-service beneficiaries within 4,506 hospitals for AMI, 4,767 hospitals for HF and 4,811 hospitals for pneumonia. Results showed that the correlations between RSMRs and RSRRs were 0.03 (95 percent CI, -0.002 to 0.06) for AMI, -0.17 (95 percent CI, -0.02 to -0.14) for heart failure, and 0.002 (95 percent CI, -0.03 to 0.03) for pneumonia. In addition, although there was a significant negative linear relationship between RSMRs and RSRRs for heart failure, the shared variance between them was only 2.9 percent (r2 = 0.029), with the correlation most prominent for hospitals with RSMR < 11 percent.

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"These findings should allay concerns that institutions with good performance on RSMRs will necessarily be identified as poor performers on their RSRRs," note the authors. Further, these findings "indicate that many institutions do well on mortality and readmission and that performance on one does not dictate performance on the other," they add.

Commenting on the study, Harlan Krumholz, MD, SM, FACC, Harold H. Hines Jr. professor of medicine and epidemiology and public health at the Yale University School of Medicine, notes "the study dispels concerns that hospitals with good mortality rates will necessarily have high readmission rates. We found that hospitals can excel in both measures – and that these measures seem to reflect very different facets of health care performance, as they are not strongly related to each other. Our goal now is to determine how the best performing hospitals are able to do well on both measures and share those lessons broadly."

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