Journal of General Internal Medicine

, Volume 28, Issue 3, pp 377–385

Hospital Performance Measures and 30-day Readmission Rates

  • Mihaela S. Stefan
  • Penelope S. Pekow
  • Wato Nsa
  • Aruna Priya
  • Lauren E. Miller
  • Dale W. Bratzler
  • Michael B. Rothberg
  • Robert J. Goldberg
  • Kristie Baus
  • Peter K. Lindenauer
Original Research

DOI: 10.1007/s11606-012-2229-8

Cite this article as:
Stefan, M.S., Pekow, P.S., Nsa, W. et al. J GEN INTERN MED (2013) 28: 377. doi:10.1007/s11606-012-2229-8

ABSTRACT

BACKGROUND

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.

OBJECTIVE

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.

RESULTS

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.

CONCLUSIONS

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.

KEY WORDS

medicarehospital readmission ratesprocess of care measurementshospital compare

Supplementary material

11606_2012_2229_MOESM1_ESM.doc (198 kb)
ESM 1(DOC 197 kb)

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Mihaela S. Stefan
    • 1
    • 2
    • 3
    • 4
  • Penelope S. Pekow
    • 4
    • 5
  • Wato Nsa
    • 6
  • Aruna Priya
    • 4
  • Lauren E. Miller
    • 6
  • Dale W. Bratzler
    • 7
  • Michael B. Rothberg
    • 1
    • 2
    • 4
  • Robert J. Goldberg
    • 8
  • Kristie Baus
    • 9
  • Peter K. Lindenauer
    • 1
    • 2
    • 4
  1. 1.Division of General Internal MedicineBaystate Medical CenterSpringfieldUSA
  2. 2.Tufts University School of MedicineBostonUSA
  3. 3.Program in Clinical and Translational Research, Sackler School of Graduate Biomedical SciencesTufts UniversityBostonUSA
  4. 4.Center for Quality of Care ResearchBaystate Medical CenterSpringfieldUSA
  5. 5.Division of Biostatistics and Epidemiology, Department of Public HealthUniversity of Massachusetts-AmherstAmherstUSA
  6. 6.Oklahoma Foundation for Medical QualityOklahoma CityUSA
  7. 7.Health Sciences Center College of Public HealthUniversity of OklahomaOklahoma CityUSA
  8. 8.Department of Quantitative Health SciencesUniversity of MassachusettsWorcesterUSA
  9. 9.Quality Measures Health Assessment GroupCenter for Medicare & Medicaid ServicesBaltimoreUSA