Background: The Centers for Medicare and Medicaid (CMS) Hospital Readmissions Reduction Program (HRRP) aims to reduce 30-day readmission rates for patients with acute myocardial infarction, heart failure, pneumonia, chronic obstructive pulmonary disease and hip/knee arthroplasty. The impact of hyperglycemia on readmission rates for these diagnoses is not known.
Methods: We analyzed 30-day readmission rates for patients discharged from Florida Hospital Orlando with CMS HRRP diagnoses from July 1, 2014 through June 30, 2017. Subjects were grouped according to eligibility (2 point-of-care glucoses within 24 hours) for our glycemic monitoring program (GMP) or not (non-GMP). The GMP group was further divided into controlled (C-GMP, mean blood glucose during hospitalization 70-180 mg/dL) and hyperglycemic (H-GMP, mean blood glucose > 180 mg/dL) groups.
Results: The GMP group had significantly higher readmission rates than the non-GMP group, as did the H-GMP group relative to the C-GMP group (Table). These differences remained significant after adjusting for difference in age, sex, diagnosis, case mix index and other factors in logistic regression analyses.
Conclusion: Hyperglycemic patients discharged with a CMS HRRP diagnosis have higher 30-day readmission rates. Strategies to prevent readmission should target glycemic control during and after hospitalization.
| Variable | Non-GMP | GMP | C-GMP | H-GMP |
| N | 17675 | 17008 | 11120 | 5888 |
| Female % | 53.9% | 49.8% | 49.7% | 49.9% |
| White % | 78.5% | 71.8% | 71.0% | 73.3% |
| Age (years) | 67 | 68 | 69 | 67 |
| Weight (kg) | 80.2 | 88 | 85.5 | 92.7 |
| Case Mix Index | 1.49 | 2.07 | 2.31 | 1.61 |
| 30-Day Readmission Rate (%) | 14.4 | 21.5** | 21.1 | 22.3* |
| Variable | Non-GMP | GMP | C-GMP | H-GMP |
| N | 17675 | 17008 | 11120 | 5888 |
| Female % | 53.9% | 49.8% | 49.7% | 49.9% |
| White % | 78.5% | 71.8% | 71.0% | 73.3% |
| Age (years) | 67 | 68 | 69 | 67 |
| Weight (kg) | 80.2 | 88 | 85.5 | 92.7 |
| Case Mix Index | 1.49 | 2.07 | 2.31 | 1.61 |
| 30-Day Readmission Rate (%) | 14.4 | 21.5** | 21.1 | 22.3* |
* P < 0.05, ** P < 0.01 in risk-adjusted logistic regression analyses.
M. Gaines: None. R.E. Pratley: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Pfizer Inc., Sanofi-Aventis, Takeda Development Center Americas, Inc..
