Journal of General Internal Medicine

, Volume 28, Issue 3, pp 377–385 | Cite as

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



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.


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.


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.


medicare hospital readmission rates process of care measurements hospital compare 



Dr. Stefan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Stefan, Lindenauer, Bratzler, Nsa, Pekow, Rothberg

Analysis and interpretation of the data: Miller, Nsa, Priya, Pekow, Stefan, Lindenauer

Drafting of the manuscript: Stefan

Critical revision of the manuscript for important intellectual content: Stefan, Lindenauer, Pekow, Nsa, Rothberg, Bratzler, Goldberg, Baus

We thank Ms. Dana Auden MS for her contribution to the statistical analysis of this study. Ms Auden was employed by Oklahoma Foundation for Medical Quality during the project, which led to this publication. Ms. Auden was not compensated for this work.

The analyses upon which this publication is based were performed under Contract Number HHSM-500-2008-OK9THC, entitled “Utilization and Quality Control Peer Review Organization for the State Oklahoma,” sponsored by the Centers for Medicare & Medicaid Services, an agency of the Department of Health & Human Services. The contents of this publication does not necessarily reflect the views or policies of the Department of Health & Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility of the accuracy and completeness of the ideas presented. 4-1399-OK-0212

This study was also supported by a Baystate Health Incubator fund and internal Center for Quality of Care departmental funds.

Dr. Stefan is supported by KM1 CA156726 from the National Cancer Institute (NCI) and by the National Center for Research Resources (UL1 RR025752). The content of this publication is solely the responsibility of the authors and does not represent the official views of NIH, NCRR or NCI.

The sponsors did not have any role in the design and conduct of the study, in the collection, management, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

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


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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

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