title: Development and Validation of an Algorithm to Identify Planned Readmissions From Claims Data.
abstract: BACKGROUND
  It is desirable not to include planned readmissions in readmission measures because they represent deliberate, scheduled care.
  
  
  OBJECTIVE
  To develop an algorithm to identify planned readmissions, describe its performance characteristics, and identify improvements.
  
  
  METHODS
  Consensus-driven algorithm development and chart review validation study at 7 acute-care hospitals in 2 health systems.
  
  
  METHODS
  For development, all discharges qualifying for the publicly reported hospital-wide readmission measure. For validation, all qualifying same-hospital readmissions that were characterized by the algorithm as planned, and a random sampling of same-hospital readmissions that were characterized as unplanned.
  
  
  METHODS
  We calculated weighted sensitivity and specificity, and positive and negative predictive values of the algorithm (version 2.1), compared to gold standard chart review.
  
  
  RESULTS
  In consultation with 27 experts, we developed an algorithm that characterizes 7.8% of readmissions as planned. For validation we reviewed 634 readmissions. The weighted sensitivity of the algorithm was 45.1% overall, 50.9% in large teaching centers and 40.2% in smaller community hospitals. The weighted specificity was 95.9%, positive predictive value was 51.6%, and negative predictive value was 94.7%. We identified 4 minor changes to improve algorithm performance. The revised algorithm had a weighted sensitivity 49.8% (57.1% at large hospitals), weighted specificity 96.5%, positive predictive value 58.7%, and negative predictive value 94.5%. Positive predictive value was poor for the 2 most common potentially planned procedures: diagnostic cardiac catheterization (25%) and procedures involving cardiac devices (33%).
  
  
  CONCLUSIONS
  An administrative claims-based algorithm to identify planned readmissions is feasible and can facilitate public reporting of primarily unplanned readmissions.
authors.affiliation: Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, New York.|Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center, New York, New York.|Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Leora I
authors.identifier: http://orcid.org/0000-0003-1800-6040
authors.initials: LI
authors.lastname: Horwitz
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Jacqueline N
authors.initials: JN
authors.lastname: Grady
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Dorothy B
authors.initials: DB
authors.lastname: Cohen
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Zhenqiu
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.|Yale Physician Associate Program, Yale School of Medicine, New Haven, CT.
authors.forename: Mark
authors.initials: M
authors.lastname: Volpe
authors.affiliation: Yale Physician Associate Program, Yale School of Medicine, New Haven, CT.
authors.forename: Chi K
authors.initials: CK
authors.lastname: Ngo
authors.affiliation: Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Masica
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Theodore
authors.initials: T
authors.lastname: Long
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jessica
authors.initials: J
authors.lastname: Wang
authors.affiliation: Yale Physician Associate Program, Yale School of Medicine, New Haven, CT.
authors.forename: Megan
authors.initials: M
authors.lastname: Keenan
authors.affiliation: Yale Physician Associate Program, Yale School of Medicine, New Haven, CT.
authors.forename: Julia
authors.initials: J
authors.lastname: Montague
authors.affiliation: Yale Physician Associate Program, Yale School of Medicine, New Haven, CT.|Section of Rheumatology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Suter
authors.affiliation: Yale Physician Associate Program, Yale School of Medicine, New Haven, CT.|Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.|Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.affiliation: Yale Physician Associate Program, Yale School of Medicine, New Haven, CT.|Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Drye
authors.affiliation: Yale Physician Associate Program, Yale School of Medicine, New Haven, CT.|Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.|Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut.|Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: Yale Physician Associate Program, Yale School of Medicine, New Haven, CT.|Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Susannah M
authors.initials: SM
authors.lastname: Bernheim
mesh_terms: D000368:Aged; D000465:Algorithms; D018588:Fee-for-Service Plans; D006788:Hospitals, Voluntary; D006801:Humans; D007345:Insurance Claim Review; D006278:Medicare; D010359:Patient Readmission; D012680:Sensitivity and Specificity; D014481:United States