title: Evaluation of hospital readmissions in surgical patients: do administrative data tell the real story?
abstract: OBJECTIVE
  The Centers for Medicare & Medicaid Services has developed an all-cause readmission measure that uses administrative data to measure readmission rates and financially penalize hospitals with higher-than-expected readmission rates.
  
  
  OBJECTIVE
  To examine the accuracy of administrative codes in determining the cause of readmission as determined by medical record review, to evaluate the readmission measure's ability to accurately identify a readmission as planned, and to document the frequency of readmissions for reasons clinically unrelated to the original hospital stay.
  
  
  METHODS
  Retrospective review of all consecutive patients discharged from general surgery services at a tertiary care, university-affiliated teaching hospital during 8 consecutive quarters (quarter 4 [October through December] of 2009 through quarter 3 [July through September] of 2011). Clinical readmission diagnosis determined from direct medical record review was compared with the administrative diagnosis recorded in a claims database. The number of planned hospital readmissions defined by the readmission measure was compared with the number identified using clinical data. Readmissions unrelated to the original hospital stay were identified using clinical data.
  
  
  METHODS
  Discordance rate between administrative and clinical diagnoses for all hospital readmissions, discrepancy between planned readmissions defined by the readmission measure and identified by clinical medical record review, and fraction of hospital readmissions unrelated to the original hospital stay.
  
  
  RESULTS
  Of the 315 hospital readmissions, the readmission diagnosis listed in the administrative claims data differed from the clinical diagnosis in 97 readmissions (30.8%). The readmission measure identified 15 readmissions (4.8%) as planned, whereas clinical data identified 43 readmissions (13.7%) as planned. Unrelated readmissions comprised 70 of the 258 unplanned readmissions (27.1%).
  
  
  CONCLUSIONS
  Administrative billing data, as used by the readmission measure, do not reliably describe the reason for readmission. The readmission measure accounts for less than half of the planned readmissions and does not account for the nearly one-third of readmissions unrelated to the original hospital stay. Implementation of this readmission measure may result in unwarranted financial penalties for hospitals.
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: Greg D
authors.initials: GD
authors.lastname: Sacks
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Dawes
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles)2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Russell
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: Anne Y
authors.initials: AY
authors.lastname: Lin
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles)2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Melinda
authors.initials: M
authors.lastname: Maggard-Gibbons
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: Deborah
authors.initials: D
authors.lastname: Winograd
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: Hallie R
authors.initials: HR
authors.lastname: Chung
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles)2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: James
authors.initials: J
authors.lastname: Tomlinson
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: Areti
authors.initials: A
authors.lastname: Tillou
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Shew
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: Darryl T
authors.initials: DT
authors.lastname: Hiyama
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: H Gill
authors.initials: HG
authors.lastname: Cryer
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: F Charles
authors.initials: FC
authors.lastname: Brunicardi
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles)2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Clifford
authors.initials: C
authors.lastname: Ko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008499:Medical Records; D006278:Medicare; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult