An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure.
BACKGROUND
Readmission soon after hospital discharge is an expensive and often preventable event for patients with heart failure. We present a model approved by the National Quality Forum for the purpose of public reporting of hospital-level readmission rates by the Centers for Medicare & Medicaid Services.


RESULTS
We developed a hierarchical logistic regression model to calculate hospital risk-standardized 30-day all-cause readmission rates for patients hospitalized with heart failure. The model was derived with the use of Medicare claims data for a 2004 cohort and validated with the use of claims and medical record data. The unadjusted readmission rate was 23.6%. The final model included 37 variables, had discrimination ranging from 15% observed 30-day readmission rate in the lowest predictive decile to 37% in the upper decile, and had a c statistic of 0.60. The 25th and 75th percentiles of the risk-standardized readmission rates across 4669 hospitals were 23.1% and 24.0%, with 5th and 95th percentiles of 22.2% and 25.1%, respectively. The odds of all-cause readmission for a hospital 1 standard deviation above average was 1.30 times that of a hospital 1 standard deviation below average. State-level adjusted readmission rates developed with the use of the claims model are similar to rates produced for the same cohort with the use of a medical record model (correlation, 0.97; median difference, 0.06 percentage points).


CONCLUSIONS
This claims-based model of hospital risk-standardized readmission rates for heart failure patients produces estimates that may serve as surrogates for those derived from a medical record model.
Keenan
Patricia S
PS
Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT 06520-8088, USA.
Normand
Sharon-Lise T
SL
Lin
Zhenqiu
Z
Drye
Elizabeth E
EE
Bhat
Kanchana R
KR
Ross
Joseph S
JS
Schuur
Jeremiah D
JD
Stauffer
Brett D
BD
Bernheim
Susannah M
SM
Epstein
Andrew J
AJ
Wang
Yongfei
Y
Herrin
Jeph
J
Chen
Jersey
J
Federer
Jessica J
JJ
Mattera
Jennifer A
JA
Wang
Yun
Y
Krumholz
Harlan M
HM
D005260:Female; D006333:Heart Failure / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D006278:Medicare; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012986:Software Validation; D014481:United States