Hospital Performance Measures and 30-day Readmission Rates
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Lowering hospital readmission rates has become a primary target for the Centers for Medicare & Medicaid Services, but studies of the relationship between adherence to the recommended hospital care processes and readmission rates have provided inconsistent and inconclusive results.
To examine the association between hospital performance on Medicare’s Hospital Compare process quality measures and 30-day readmission rates for patients with acute myocardial infarction (AMI), heart failure and pneumonia, and for those undergoing major surgery.
DESIGN, SETTING AND PARTICIPANTS
We assessed hospital performance on process measures using the 2007 Hospital Inpatient Quality Reporting Program. The process measures for each condition were aggregated in two separate measures: Overall Measure (OM) and Appropriate Care Measure (ACM) scores. Readmission rates were calculated using Medicare claims.
MAIN OUTCOME MEASURE
Risk-standardized 30-day all-cause readmission rate was calculated as the ratio of predicted to expected rate standardized by the overall mean readmission rate. We calculated predicted readmission rate using hierarchical generalized linear models and adjusting for patient-level factors.
Among patients aged ≥ 66 years, the median OM score ranged from 79.4 % for abdominal surgery to 95.7 % for AMI, and the median ACM scores ranged from 45.8 % for abdominal surgery to 87.9 % for AMI. We observed a statistically significant, but weak, correlation between performance scores and readmission rates for pneumonia (correlation coefficient R = 0.07), AMI (R = 0.10), and orthopedic surgery (R = 0.06). The difference in the mean readmission rate between hospitals in the 1st and 4th quartiles of process measure performance was statistically significant only for AMI (0.25 percentage points) and pneumonia (0.31 percentage points). Performance on process measures explained less than 1 % of hospital-level variation in readmission rates.
Hospitals with greater adherence to recommended care processes did not achieve meaningfully better 30-day hospital readmission rates compared to those with lower levels of performance.
- Hospital Performance Measures and 30-day Readmission Rates
Journal of General Internal Medicine
Volume 28, Issue 3 , pp 377-385
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- hospital readmission rates
- process of care measurements
- hospital compare
- Industry Sectors
- Author Affiliations
- 1. Division of General Internal Medicine, Baystate Medical Center, 756 Chestnut Street, Springfield, MA, USA
- 2. Tufts University School of Medicine, Boston, MA, USA
- 3. Program in Clinical and Translational Research, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, USA
- 4. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA
- 5. Division of Biostatistics and Epidemiology, Department of Public Health, University of Massachusetts-Amherst, Amherst, MA, USA
- 6. Oklahoma Foundation for Medical Quality, Oklahoma City, OK, USA
- 7. Health Sciences Center College of Public Health, University of Oklahoma, Oklahoma City, OK, USA
- 8. Department of Quantitative Health Sciences, University of Massachusetts, Worcester, MA, USA
- 9. Quality Measures Health Assessment Group, Center for Medicare & Medicaid Services, Baltimore, MD, USA