title: Variation in the risk of readmission among hospitals: the relative contribution of patient, hospital and inpatient provider characteristics.
abstract: BACKGROUND
  The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with excess readmissions. The contribution of patient characteristics, hospital characteristics and provider type to the variation in risk of readmission among hospitals has not been determined.
  
  
  OBJECTIVE
  To describe the variation in risk of readmission among hospitals and partition it by patient characteristics, hospital characteristics and provider type.
  
  
  METHODS
  Retrospective research design of 100% Texas Medicare data using multilevel, multivariable models.
  
  
  METHODS
  A total of 514,064 admissions of Medicare beneficiaries to 272 hospitals in Texas for medical diagnoses during the years 2008 and 2009.
  
  
  METHODS
  Using hierarchical generalized linear models, we describe the hospital-specific variation in risk of readmission that is attributable to patients characteristics, hospital characteristics and provider type by measuring the variance and intraclass correlation coefficients.
  
  
  RESULTS
  Of the total variation in risk of readmission, only a small amount (0.84%) is attributed to hospitals. In further analyses modeling the components of this variation among hospitals, differences in patient characteristics in the hospitals explained 56.2% of the variation. Hospital characteristics and the type of provider explained 9.3% of the variation among hospitals and 0.08% of the total variation in risk of readmission.
  
  
  CONCLUSIONS
  Patient characteristics are the largest contributor to variation in risk of readmission among hospitals. Measurable hospital characteristics and the type of inpatient provider contribute little to variation in risk of readmission among hospitals.
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA, ssingh@mcw.edu.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Singh
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Lin
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards; D015331:Cohort Studies; D005260:Female; D006761:Hospitals / Q000592:standards / Q000639:trends*; D006801:Humans; D007297:Inpatients; D008297:Male; D006278:Medicare / Q000592:standards / Q000639:trends*; D010358:Patient Participation / Q000639:trends*; D010359:Patient Readmission / Q000592:standards / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D014481:United States / Q000453:epidemiology