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Statistical Tool Helps Cut Heart Failure Readmissions



Medical researchers at Intermountain Heart Institute in Murray, Utah developed a statistical index that evaluates a cardiac patient’s condition and calculates the risk of readmission for the same disorder within 30 days. The team led by Benjamin Horne, director of cardiovascular and genetic epidemiology at the institute, a division of Intermountain Medical Center in Salt Lake City, described the technique on Saturday at a meeting of the American College of Cardiology in San Francisco.

Under the Affordable Care Act of 2010, hospitals can suffer Medicare reimbursement penalties for heart attack, heart failure, or pneumonia patients who are discharged but then readmitted within 30 days for the same condition. The penalties started at 1 percent in 2012, but grow to 3 percent in 2014. A study by the Commonwealth Fund released in late February shows more than 2,200 hospitals faced some kind of penalty in 2012, at a cost of $125,000 per hospital. The program is expected to save Medicare some $8.2 billion over seven years.

Horne’s team adapted a statistical index known as the Intermountain Risk Score (IMRS) for heart failure patients to devise the technique known as IMRS-HF. IMRS is used by Intermountain’s facilities to predict mortality rates in trauma patients. The researchers reviewed of more than 6,000 electronic medical records for heart failure patients discharged from Intermountain between 1999 and 2011 to construct the index.

The technique was validated with 459 patients hospitalized for heart failure at Intermountain between April 2011 and October 2012. The tests show male patients with an IMRS-HF score of 15 or more, out of a maximum of 19, were 8.5 times more likely to be readmitted within 30 days compared to a male patient with a score between 1 and 8. Female patients with IMRS-HF scores of 5 to 9 — of a maximum of 9; the index has different scoring methods for men and women — were twice as likely to be readmitted than female patients with scores of 3 or lower.

Horne calls IMRS-HF “another step forward in using evidence-based care to improve the quality of medical care,” and adds that the index “gives physicians an effective, real-time tool to help assure patients are in a healthy position for discharge.”

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