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.
- Bernheim, SM, Grady, JN, Lin, Z (2010) National patterns of risk-standardized mortality and readmission for acute myocardial infarction and heart failure. Update on publicly reported outcomes measures based on the 2010 release. Circ Cardiovasc Qual Outcomes 3: pp. 459-467 CrossRef
- Bueno, H, Ross, JS, Wang, Y (2010) Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. JAMA 303: pp. 2141-2147 CrossRef
- Epstein, AM (2009) Revisiting readmissions–changing the incentives for shared accountability. N Engl J Med 360: pp. 1457-1459 CrossRef
- Ross JS, Chen J, Lin Z, et al. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail. Jan;3(1):97–103.
- Jencks, SF, Williams, MV, Coleman, EA (2009) Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360: pp. 1418-1428 CrossRef
- Report to the congress: Promoting greater efficiency in Medicare. MedPAC, Washington, DC
- Ashton, CM, Junco, DJ, Souchek, J, Wray, NP, Mansyur, CL (1997) The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. Med Care 35: pp. 1044-1059 CrossRef
- Chung, ES, Lin, G, Casey, DE (2008) Relationship of a quality measure composite to clinical outcomes for patients with heart failure. Am J Med Qual 23: pp. 168-175 CrossRef
- Shahian, DM, Meyer, GS, Mort, E (2012) Association of national hospital quality measure adherence with long-term mortality and readmissions. BMJ Qual Saf 21: pp. 325-336 CrossRef
- Polanczyk, CA, Newton, C, Dec, GW, Salvo, TG (2001) Quality of care and hospital readmission in congestive heart failure: an explicit review process. J Card Fail 7: pp. 289-298 CrossRef
- Centers for Medicare and Medicaid. Hospital Compare. http://www.hospitalcompare.hhs.gov/. Accessed September 13, 2012.
- Werner, RM, Bradlow, ET (2006) Relationship between Medicare’s hospital compare performance measures and mortality rates. JAMA 296: pp. 2694-2702 CrossRef
- Jha AK, OE, Li, Z, Epstein, AM (2007) The inverse relationship between mortality rates and performance in the hospital quality alliance measures. Health Aff (Millwood) 26: pp. 1104-1110 CrossRef
- Fonarow, GC, Abraham, WT, Albert, NM (2007) Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA 297: pp. 61-70 CrossRef
- Hospital Inpatient Quality Reporting Program. www.qualitynet.org/. Accessed September 13, 2012.
- Specifications Manual for National Hospital Quality Measures, version 1.04a, Apendix A. http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx. Accessed September 13, 2012.
- CMS Historical Impact Files. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Historical-Impact-Files-for-FY-1994-through-Present.html. Accessed September 13, 2012.
- Hospital Inpatient Quality Reporting Program http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html. Accessed September 13, 2012.
- Statistical methods to calculate 30-day risk standardized rates of readmission. http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier4&cid=1219069855841. Accessed September 13, 2012.
- Joint Commision on Accreditation of Healthcare Organizations. Quality report user guide. http://www.jointcommission.org/. Accessed September 13, 2012.
- Nolan, T, Berwick, DM (2006) All-or-none measurement raises the bar on performance. JAMA 295: pp. 1168-1170 CrossRef
- Healthcare Cost and Utilization Project (HCUP). Comorbidity Software, version 3.6. Rockville, MD: Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp. Accessed September 13, 2012.
- Elixhauser, A, Steiner, C, Harris, DR, Coffey, RM (1998) Comorbidity measures for use with administrative data. Med Care 36: pp. 8-27 CrossRef
- Shepperd, S, Parkes, J, McClaren, J, Phillips, C (2004) Discharge planning from hospital to home. Cochrane Database Syst Rev 1: pp. CD000313
- Walraven, C, Seth, R, Austin, PC, Laupacis, A (2002) Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med 17: pp. 186-192 CrossRef
- Jack, BW, Chetty, VK, Anthony, D (2009) A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med 150: pp. 178-187
- Parrish, MM, O’Malley, K, Adams, RI, Adams, SR, Coleman, EA (2009) Implementation of the care transitions intervention: sustainability and lessons learned. Prof Case Manag 14: pp. 282-293
- Parry, C, Min, SJ, Chugh, A, Chalmers, S, Coleman, EA (2009) Further application of the care transitions intervention: results of a randomized controlled trial conducted in a fee-for-service setting. Home Health Care Serv Q 28: pp. 84-99 CrossRef
- Coleman, EA, Smith, JD, Frank, JC, Min, SJ, Parry, C, Kramer, AM (2004) Preparing patients and caregivers to participate in care delivered across settings: the care transitions intervention. J Am Geriatr Soc 52: pp. 1817-1825 CrossRef
- Daly, BJ, Douglas, SL, Kelley, CG, O’Toole, E, Montenegro, H (2005) Trial of a disease management program to reduce hospital readmissions of the chronically critically ill. Chest 128: pp. 507-517 CrossRef
- Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med. Apr 2 1981;304(14):801–7.
- Pfeffer, MA, Lamas, GA, Vaughan, DE, Parisi, AF, Braunwald, E (1988) Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med 319: pp. 80-86 CrossRef
- Pfeffer, MA, McMurray, JJ, Velazquez, EJ (2003) Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 349: pp. 1893-1906 CrossRef
- Fung, CH, Lim, YW, Mattke, S, Damberg, C, Shekelle, PG (2008) Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med 148: pp. 111-123
- Hibbard, JH, Stockard, J, Tusler, M (2003) Does publicizing hospital performance stimulate quality improvement efforts?. Health Aff (Millwood) 22: pp. 84-94 CrossRef
- Jha, AK, Orav, EJ, Epstein, AM (2009) Public reporting of discharge planning and rates of readmissions. N Engl J Med 361: pp. 2637-2645 CrossRef
- Lindenauer, PK, Bernheim, SM, Grady, JN (2010) The performance of US hospitals as reflected in risk-standardized 30-day mortality and readmission rates for medicare beneficiaries with pneumonia. J Hosp Med 5: pp. E12-18 CrossRef
- Keenan, PS, Normand, SL, Lin, Z (2008) An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 1: pp. 29-37 CrossRef
- Bernheim, SM, Wang, Y, Bradley, EH (2010) Who is missing from the measures? Trends in the proportion and treatment of patients potentially excluded from publicly reported quality measures. Am Heart J 160: pp. 943-950 CrossRef
- Rathore, SS, Wang, Y, Radford, MJ, Ordin, DL, Krumholz, HM (2003) Quality of care of Medicare beneficiaries with acute myocardial infarction: who is included in quality improvement measurement?. J Am Geriatr Soc 51: pp. 466-475 CrossRef
- Bratzler DW, Ma A, Nsa W, Fleisher L. Performance on SCIP Measures and Risk of Surgical Site Infection IDSA. Boston; 2011.
- 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