Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission.
BACKGROUND
Existing publicly reported readmission measures are condition-specific, representing less than 20% of adult hospitalizations. An all-condition measure may better measure quality and promote innovation.


OBJECTIVE
To develop an all-condition, hospital-wide readmission measure.


METHODS
Measure development study.


METHODS
4821 U.S. hospitals.


METHODS
Medicare fee-for-service beneficiaries aged 65 years or older.


METHODS
Hospital-level, risk-standardized unplanned readmissions within 30 days of discharge. The measure uses Medicare fee-for-service claims and is a composite of 5 specialty-based, risk-standardized rates for medicine, surgery/gynecology, cardiorespiratory, cardiovascular, and neurology cohorts. The 2007-2008 admissions were randomly split for development and validation. Models were adjusted for age, principal diagnosis, and comorbid conditions. Calibration in Medicare and all-payer data was examined, and hospital rankings in the development and validation samples were compared.


RESULTS
The development data set contained 8 018 949 admissions associated with 1 276 165 unplanned readmissions (15.9%). The median hospital risk-standardized unplanned readmission rate was 15.8 (range, 11.6 to 21.9). The 5 specialty cohort models accurately predicted readmission risk in both Medicare and all-payer data sets for average-risk patients but slightly overestimated readmission risk at the extremes. Overall hospital risk-standardized readmission rates did not differ statistically in the split samples (P = 0.71 for difference in rank), and 76% of hospitals' validation-set rankings were within 2 deciles of the development rank (24% were more than 2 deciles). Of hospitals ranking in the top or bottom deciles, 90% remained within 2 deciles (10% were more than 2 deciles) and 82% remained within 1 decile (18% were more than 1 decile).


CONCLUSIONS
Risk adjustment was limited to that available in claims data.


CONCLUSIONS
A claims-based, hospital-wide unplanned readmission measure for profiling hospitals produced reasonably consistent results in different data sets and was similarly calibrated in both Medicare and all-payer data.


BACKGROUND
Centers for Medicare & Medicaid Services.
Leora I
LI
Horwitz
Chohreh
C
Partovian
Zhenqiu
Z
Lin
Jacqueline N
JN
Grady
Jeph
J
Herrin
Mitchell
M
Conover
Julia
J
Montague
Chloe
C
Dillaway
Kathleen
K
Bartczak
Lisa G
LG
Suter
Joseph S
JS
Ross
Susannah M
SM
Bernheim
Harlan M
HM
Krumholz
Elizabeth E
EE
Drye
D000368:Aged; D018588:Fee-for-Service Plans; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data; D058996:Quality Improvement; D020379:Risk Adjustment; D014481:United States