title: Effect of clinical and social risk factors on hospital profiling for stroke readmission: a cohort study.
abstract: BACKGROUND
  The Centers for Medicare & Medicaid Services (CMS) and Veterans Health Administration (VA) will report 30-day stroke readmission rates as a measure of hospital quality. A national debate on whether social risk factors should be included in models developed for hospital profiling is ongoing.
  
  
  OBJECTIVE
  To compare a CMS-based model of 30-day readmission with a more comprehensive model that includes measures of social risk (such as homelessness) or clinical factors (such as stroke severity and functional status).
  
  
  METHODS
  Data from a retrospective cohort study were used to develop a CMS-based 30-day readmission model that included age and comorbid conditions based on codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (model 1). This model was then compared with one that included administrative social risk factors (model 2). Finally, the CMS model (model 1) was compared with a model that included social risk and clinical factors from chart review (model 3). These 3 models were used to rank hospitals by 30-day risk-standardized readmission rates and examine facility rankings among the models.
  
  
  METHODS
  Hospitals in the VA.
  
  
  METHODS
  Patients hospitalized with stroke in 2007.
  
  
  METHODS
  30-day readmission rates.
  
  
  RESULTS
  The 30-day readmission rate was 12.8%. The c-statistics for the 3 models were 0.636, 0.646, and 0.661, respectively. All hospitals were classified as performing "as expected" using all 3 models (that is, performance did not differ from the VA national average); therefore, the addition of detailed clinical information or social risk factors did not alter assessment of facility performance.
  
  
  CONCLUSIONS
  A predominantly male veteran cohort limits the generalizability of these findings.
  
  
  CONCLUSIONS
  In the VA, more comprehensive models that included social risk and clinical factors did not affect hospital comparisons based on 30-day readmission rates.
  
  
  BACKGROUND
  U.S. Department of Veterans Affairs.
authors.forename: Salomeh
authors.initials: S
authors.lastname: Keyhani
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Myers
authors.forename: Eric
authors.initials: E
authors.lastname: Cheng
authors.forename: Paul
authors.initials: P
authors.lastname: Hebert
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005260:Female; D006703:Ill-Housed Persons; D006787:Hospitals, Veterans / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011203:Poverty; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis*; D014481:United States; D014493:United States Department of Veterans Affairs