Objectives:
To investigate the etiology of the high heart failure (HF) 30 day re admission rate by using Clinical Looking Glass (CLG) in order to improve quality of care
Methods:
CLG is a patented software tool designed at Montefiore to time-effectively acquire medical data to improve patient care and clinical practice. Using CLG we looked into all patients admitted with the primary diagnosis of heart failure in 2010 and re-admitted in 30 days. ICD 9 codes used- 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, and 428.9. 12,851 patients were admitted for HF and 2657 (20%) were readmitted in 30 days. We randomly picked 50 patients from the 30 day readmit group and performed chart reviews on them. We compared the baseline characteristics of both groups to assure that the 50 patients were representative of the whole group.
Results:
Out of the 12851 patients admitted with the diagnosis of HF in 2010 (51% Female, 49% male, 34% Black, 27% White, 29% other), 70% had Medicare, 22% Medicaid, 8% Private insurance. Overall, 39% were discharged home, 28% Skilled nursing facility, and 25% other. The representative 50 patients had a similar breakdown of demographics and baseline characteristics.
Conclusions:
60% of the patients were incorrectly coded as being admitted for CHF. Only 16% of the 50 patients had a 30-day CHF readmission that was correctly diagnosed. This preliminary observation raises doubt about reliance on hospital coding system to determine overall quality of care and performance.
Baseline characteristics, quality of care, and outcomes of younger and older Medicare beneficiaries hospitalized with heart failure: Findings from the Alabama Heart Failure Project
