Measuring readmissions after surgery: do different methods tell the same story?
BACKGROUND
Readmission is widely used as a quality metric to assess hospital performance. However, different methods to calculate readmissions may produce various results, leading to differences in classification with respect to hospital performance. This study compared 2 commonly used approaches to measure surgical readmissions: the 30-day all-cause hospital-wide readmissions (HWRs) and the potentially preventable readmissions (PPRs).


METHODS
We examined the correlation between hospitals' risk-adjusted HWR and PPR rates and whether there was agreement in categorizing hospital performance between these measures among 111 hospitals with inpatient surgical programs in the Veterans Health Administration.


RESULTS
We found that hospitals' HWR and PPR rates were highly correlated (r = .85, P < .0001). The overall agreement between these 2 methods in categorizing hospital performance was 82% for all surgeries, 82% for colectomy, 84% for coronary bypass, and 87% for hip/knee replacement, respectively.


CONCLUSIONS
Despite differences in methodologies, the HWR and the PPR measures provided relatively consistent perceptions of hospitals' performance on surgical readmissions.
Center for Healthcare Organizational and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue (152M), Boston, MA, 02130, USA. Electronic address: qi.chen2@va.gov.
Qi
Q
Chen
Center for Healthcare Organizational and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue (152M), Boston, MA, 02130, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
Hillary J
HJ
Mull
Center for Healthcare Organizational and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue (152M), Boston, MA, 02130, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
Amy K
AK
Rosen
Center for Healthcare Organizational and Implementation Research, Bedford VAMC, Bedford, MA, USA; Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA; Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Ann M
AM
Borzecki
Center for Healthcare Organizational and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue (152M), Boston, MA, 02130, USA.
Corey
C
Pilver
Department of Surgery, Boston University School of Medicine, Boston, MA, USA; Department of Surgery, VA Boston Healthcare System, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA.
Kamal M F
KM
Itani
D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D020379:Risk Adjustment; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D014481:United States; D014493:United States Department of Veterans Affairs
30-Day all-cause hospital-wide readmissions; Administrative data; Potentially preventable readmissions; Surgical readmissions; Veterans Health Administration