A Comparison of the Inpatient Mortality and 30-day Readmission Rates of Heart Failure Patients

A Comparison of the Inpatient Mortality and 30-day Readmission Rates of Heart Failure Patients

Author: 
Freling S. Smith II
Program of study: 
D.H.A.
Abstract: 
Heart failure poses a significant public health issue in the United States, consuming a disproportionate share of the Centers for Medicare and Medicaid’s annual expenditures (Ramani, Uber, & Mehra, 2010). The purpose of this retrospective quantitative study is to compare the inpatient mortality and 30-day readmissions for heart failure patients based on the patient’s proximity to the hospital treated at either New York University Hospital (NYU), located in downstate NY with a very high population density, or Albany Medical Center (AMC), located in upstate NY in a less densely populated city. A subgroup analysis of race, socioeconomic status, and gender was completed to attempt to identify potential high risk groups. The hypothesis testing did not find a statistically significant overall difference in regard to 30-day readmission rates between the two hospitals or within any of the subgroup analyses. However, both hospitals had a significantly lower percentage of multiple admissions from patients residing in the distant quartile located farthest from the hospital as compared to heart failure patients residing in the distance quartile nearest the hospital. The study did detect statistically significant inpatient mortality differences in the socioeconomic status subgroup analysis between NYU and AMC as well as a difference in the overall study population. The study results add further empirical evidence to the existence of a “decay effect” of health care service utilization as patient proximity to those services decreases.
Dedication: 
This dissertation is dedicated to my wife and my brilliant son. Know that you can accomplish anything with focus and belief in yourself. This study is also dedicated to my finest teacher my late mother Margaret Smith. It grieves me that cancer robbed you of the opportunity to help celebrate this milestone. Lastly, this dissertation is dedicated to Linda and my father. Without your constant support this doctoral journey would not have been possible.
Acknowledgements: 
I would like to acknowledge and thank my dissertation committee chair, Dr. Katherine Iaconetti as well as dissertation committee members Dr. Francine Nelson and Dr. Fiona Sussan for their feedback and encouragement. I would also like to express my sincere gratitude to my mentor Dr. Joseph Breault for all his support and encouragement during the completion of my dissertation. I would like to acknowledge Dr. Mikhail Torosoff, and all those at Albany Medical Center, New York University Hospital and SPARCS who aided me in navigating the institutional processes, protocols, and review boards required to complete this study. Lastly I would like to acknowledge all my professors at the University of Phoenix who helped me develop the necessary skill sets needed to complete this journey.