Hospital performance measures and 30-day readmission rates.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Division of General Internal Medicine, Baystate Medical Center, Springfield, MA, USA. Mihaela.stefan@bhs.org
Mihaela S
MS
Stefan
Penelope S
PS
Pekow
Wato
W
Nsa
Aruna
A
Priya
Lauren E
LE
Miller
Dale W
DW
Bratzler
Michael B
MB
Rothberg
Robert J
RJ
Goldberg
Kristie
K
Baus
Peter K
PK
Lindenauer
D000368:Aged; D003430:Cross-Sectional Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D006333:Heart Failure / Q000628:therapy; D006761:Hospitals / Q000592:standards*; D006801:Humans; D006278:Medicare; D009203:Myocardial Infarction / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000628:therapy; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D013514:Surgical Procedures, Operative / Q000592:standards; D014481:United States