Heart failure billing study: Provider connectedness to other providers reduces risk of readmission

Findings from a computational health informatics study recently published in Medical Care Research and Review suggest that provider connectedness is associated with reduced 30-day readmission rates for heart failure patients following hospital discharge.

Researchers at Boston Children’s Hospital reviewed payer claims data stored in the HealthCore Integrated Research Database, which contains longitudinal data from 14 states. They selected claims with dates of service between April 1, 2008, and September 31, 2011, for 1,429 patients admitted for heart failure. Selected cases listed an ICD-9 code for heart failure, such as 404.01 (hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified) or 425.4 (other primary cardiomyopathies), as the primary diagnosis and reason for initial hospital admission.

Using this data, researchers created schematic networks linking patients to providers, based on the outpatient encounters billed by a provider for a given patient in the 30 days following the patient’s initial discharge. A link between a patient and provider was created if the patient had at least one outpatient visit with a provider. A patient’s care network then consisted of all the providers who billed face-to-face encounters with a patient during the follow-up period. Provider-provider links were created between providers who billed outpatient care for the same patient during this period.

Researchers used these constructed networks to explore the strength and breadth of provider-provider and patient-provider relationships. Specifically, they examined provider connectedness, defined for a single provider as the number of connections from the provider to other providers in their geographic region, divided by the total number of other providers in that region, expressed as a percentage. They then examined whether there was an association between provider connectedness and readmission rates for individual patients, up to 30 days after patients were discharged.

Using a multivariate logistics regression analysis, researchers found that a higher median provider connectedness was independently associated with reduced 30-day readmission for any diagnosis after hospitalization for heart failure.

According to the study, findings do not explain the mechanism by which provider connectedness protects against readmission but support its positive influence on patient outcomes. Researchers hypothesize that greater engagement with or awareness of the practice of other providers may improve care quality.