@article {661413,
	title = {Association of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia},
	journal = {JAMA Netw Open},
	volume = {1},
	number = {5},
	year = {2018},
	month = {2018 09 07},
	pages = {e182777},
	abstract = {Importance: The US Hospital Readmissions Reduction Program (HRRP) was associated with reduced readmissions among Medicare beneficiaries hospitalized for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. It is important to assess whether there has been a signal for concomitant harm with an increase in mortality.

Objective: To evaluate whether the announcement or the implementation of HRRP was associated with an increase in either in-hospital or 30-day postdischarge mortality following hospitalization for AMI, HF, or pneumonia.

Design, Setting, and Participants: In this cohort study, using Medicare data, all hospitalizations for AMI, HF, and pneumonia were identified among fee-for-service Medicare beneficiaries aged 65 years and older from January 1, 2006, to December 31, 2014. These were assessed for changes in trends for risk-adjusted rates of in-hospital and 30-day postdischarge mortality after announcement and implementation of the HRRP using an interrupted time series framework. Analyses were done in November 2017 and December 2017.

Exposures: Announcement of the HRRP in March 2010, and implementation of its penalties in October 2012.

Main Outcomes and Measures: Monthly risk-adjusted rates of in-hospital and 30-day postdischarge mortality.

Results: The sample included 1.7 million AMI, 4 million HF, and 3.5 million pneumonia hospitalizations. Between 2006 and 2014, in-hospital mortality decreased for the 3 conditions (AMI, from 10.4\% to 9.7\%; HF, from 4.3\% to 3.5\%; pneumonia, from 5.3\% to 4.0\%) while 30-day postdischarge mortality decreased from 7.4\% to 7.0\% for AMI (P for trend ,
	keywords = {Aged, Aged, 80 and over, Cohort Studies, Female, Heart Failure, Hospitalization, Humans, Male, Medicare, Middle Aged, Myocardial Infarction, Patient Discharge, Patient Readmission, Pneumonia, Risk Factors, United States},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2018.2777},
	author = {Khera, Rohan and Dharmarajan, Kumar and Wang, Yongfei and Lin, Zhenqiu and Bernheim, Susannah M and Wang, Yun and Normand, Sharon-Lise T. and Krumholz,Harlan M.}
}
