Hospital Performance Measures and 30-day Readmission Rates
- 1.9k Downloads
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.
KEY WORDSmedicare 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.
- 1.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.PubMedCrossRefGoogle Scholar
- 4.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.Google Scholar
- 6.Medicare Payment Advisory Commission. Report to the congress: Promoting greater efficiency in Medicare. Washington, DC: MedPAC; 2007.Google Scholar
- 11.Centers for Medicare and Medicaid. Hospital Compare. http://www.hospitalcompare.hhs.gov/. Accessed September 13, 2012.
- 15.Hospital Inpatient Quality Reporting Program. www.qualitynet.org/. Accessed September 13, 2012.
- 16.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.
- 17.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.
- 18.Hospital Inpatient Quality Reporting Program http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html. Accessed September 13, 2012.
- 19.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.
- 20.Joint Commision on Accreditation of Healthcare Organizations. Quality report user guide. http://www.jointcommission.org/. Accessed September 13, 2012.
- 22.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.
- 31.Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med. Apr 2 1981;304(14):801–7.Google Scholar
- 41.Bratzler DW, Ma A, Nsa W, Fleisher L. Performance on SCIP Measures and Risk of Surgical Site Infection IDSA. Boston; 2011.Google Scholar