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, et al. 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. 2010;3(5):459–67. CrossRef
- Bueno H, Ross JS, Wang Y, et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. JAMA. 2010;303(21):2141–7. CrossRef
- Epstein AM. Revisiting readmissions–changing the incentives for shared accountability. N Engl J Med. 2009;360(14):1457–9. 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. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–28. CrossRef
- Medicare Payment Advisory Commission. Report to the congress: Promoting greater efficiency in Medicare. Washington, DC: MedPAC; 2007.
- Ashton CM, Del Junco DJ, Souchek J, Wray NP, Mansyur CL. The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. Med Care. 1997;35(10):1044–59. CrossRef
- Chung ES, Lin G, Casey DE Jr, et al. Relationship of a quality measure composite to clinical outcomes for patients with heart failure. Am J Med Qual. 2008;23(3):168–75. CrossRef
- Shahian DM, Meyer GS, Mort E, et al. Association of national hospital quality measure adherence with long-term mortality and readmissions. BMJ Qual Saf. 2012;21(4):325–36. CrossRef
- Polanczyk CA, Newton C, Dec GW, Di Salvo TG. Quality of care and hospital readmission in congestive heart failure: an explicit review process. J Card Fail. 2001;7(4):289–98. CrossRef
- Centers for Medicare and Medicaid. Hospital Compare. http://www.hospitalcompare.hhs.gov/. Accessed September 13, 2012.
- Werner RM, Bradlow ET. Relationship between Medicare’s hospital compare performance measures and mortality rates. JAMA. 2006;296(22):2694–702. CrossRef
- Jha AK OE, Li Z, Epstein AM. The inverse relationship between mortality rates and performance in the hospital quality alliance measures. Health Aff (Millwood). 2007;26(4):1104–10. CrossRef
- Fonarow GC, Abraham WT, Albert NM, et al. Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA. 2007;297(1):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. All-or-none measurement raises the bar on performance. JAMA. 2006;295(10):1168–70. 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. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27. CrossRef
- Shepperd S, Parkes J, McClaren J, Phillips C. Discharge planning from hospital to home. Cochrane Database Syst Rev. 2004;1:CD000313.
- van Walraven C, Seth R, Austin PC, Laupacis A. Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med. 2002;17(3):186–92. CrossRef
- Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178–87.
- Parrish MM, O’Malley K, Adams RI, Adams SR, Coleman EA. Implementation of the care transitions intervention: sustainability and lessons learned. Prof Case Manag. 2009;14(6):282–93. quiz 294–285.
- Parry C, Min SJ, Chugh A, Chalmers S, Coleman EA. 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. 2009;28(2–3):84–99. CrossRef
- Coleman EA, Smith JD, Frank JC, Min SJ, Parry C, Kramer AM. Preparing patients and caregivers to participate in care delivered across settings: the care transitions intervention. J Am Geriatr Soc. 2004;52(11):1817–25. CrossRef
- Daly BJ, Douglas SL, Kelley CG, O’Toole E, Montenegro H. Trial of a disease management program to reduce hospital readmissions of the chronically critically ill. Chest. 2005;128(2):507–17. 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. Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med. 1988;319(2):80–6. CrossRef
- Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003;349(20):1893–906. CrossRef
- Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med. 2008;148(2):111–23.
- Hibbard JH, Stockard J, Tusler M. Does publicizing hospital performance stimulate quality improvement efforts? Health Aff (Millwood). 2003;22(2):84–94. CrossRef
- Jha AK, Orav EJ, Epstein AM. Public reporting of discharge planning and rates of readmissions. N Engl J Med. 2009;361(27):2637–45. CrossRef
- Lindenauer PK, Bernheim SM, Grady JN, et al. The performance of US hospitals as reflected in risk-standardized 30-day mortality and readmission rates for medicare beneficiaries with pneumonia. J Hosp Med. 2010;5(6):E12–18. CrossRef
- Keenan PS, Normand SL, Lin Z, et al. 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. 2008;1(1):29–37. CrossRef
- Bernheim SM, Wang Y, Bradley EH, et al. Who is missing from the measures? Trends in the proportion and treatment of patients potentially excluded from publicly reported quality measures. Am Heart J. 2010;160(5):943–50. e941-945. CrossRef
- Rathore SS, Wang Y, Radford MJ, Ordin DL, Krumholz HM. Quality of care of Medicare beneficiaries with acute myocardial infarction: who is included in quality improvement measurement? J Am Geriatr Soc. 2003;51(4):466–75. 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