Is same-hospital readmission rate a good surrogate for all-hospital readmission rate?
BACKGROUND
The Centers for Medicare & Medicaid Services (CMS) readmission measure is based on all-cause readmissions to any hospital within 30 days of discharge. Whether a measure based on same-hospital readmission, an outcome that is easier for hospitals and some systems to track, could serve as a proxy for the all-hospital measure is not known.


OBJECTIVE
Evaluate whether same-hospital readmission rate is a good surrogate for all-hospital readmission rate.


METHODS
The study population was derived from the Medicare inpatient, outpatient, and carrier (physician) Standard Analytic Files. Thirty-day risk-standardized readmission rates (RSRRs) for heart failure (HF) for both all-hospital readmission and same-hospital readmission were assessed by using hierarchical logistic regression models.


METHODS
The sample consisted of 501,234 hospitalizations in 4674 hospitals with at least 1 hospitalization.


METHODS
Thirty-day readmission was defined as occurrence of at least 1 hospitalization in any US acute care hospital for any cause within 30 days of discharge after an index hospitalization. Same-hospital readmission was considered if the patient was admitted to the hospital that produced the original discharge within 30 days.


RESULTS
Overall, 80.9% of all HF readmissions occurred in the same- hospital, whereas 19.1% of readmissions occurred in a different hospital. The mean difference between all- versus same-hospital RSRR was 4.7 +/- 1.0%, ranging from 0.9% to 10.5% across these hospitals with 25th, 50th, and 75th percentiles of 4.1%, 4.7%, and 5.2%, respectively, and was variable across the range of average RSRR.


CONCLUSIONS
Same-hospital readmission rate is an unreliable and biased indicator of all-hospital readmission rate with limited value as a benchmark for quality of care processes.
Nasir
Khurram
K
Department of Internal Medicine, Boston Medical Center, Boston, MA, USA.
Lin
Zhenqiu
Z
Bueno
Hector
H
Normand
Sharon-Lise T
SL
Drye
Elizabeth E
EE
Keenan
Patricia S
PS
Krumholz
Harlan M
HM
D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D007345:Insurance Claim Review; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D014481:United States