OBJECTIVES: The study aimed to determine an association between unplanned 30-day Heart Failure (HF) readmission rates and factors outside of hospital’s control among Medicare and Medicaid patients in Texas.

METHODS: We used the Texas Hospital Inpatient Research Data File (RDF) to select Medicare and Medicaid patients discharged with a principal diagnosis of heart failure (HF) during the January 1st, through December 31st, 2014. We applied an endorsed measure by the National Quality Forum (NQF) to develop analytic sample. Multi-level logistic regression analyses examined patient-level and community-level characteristics.

RESULTS: The unplanned 30-day HF readmission rates were 20.76% in Medicare (5,392 readmission/25,978 HF admission) vs. 30.63% in Medicaid (939 readmission/3066 HF admission). Controlled for other factors, Medicaid patients were 1.51 times more likely to be readmitted within 30 days than Medicare patients. (OR: 1.51 95% CI 1.38 - 1.65, p< 0.001). Patients lived in area with higher median household income were less likely to be readmitted (OR: 0.89, 95% CI 0.83 - 0.95, p < 0.001). The odds ratios were significantly lower in counties with higher density of health professionals (Primary care physician per 100K - OR: 0.89, 95%CI 0.80 - 0.99, p=0.025, Ratio general practitioner to specialist – OR: 0.89 95%CI 0.80 - 0.99, p=0.025, Hospital bed per 100K – OR: 0.90, 95%CI 0.83 - 0.99, p=0.032)

CONCLUSIONS: Policy makers should consider a multidisciplinary strategy to help hospitals serving higher composition of patients with lower socioeconomic status or lower access to care to achieve higher performance.