Readmission rates may skew hospital quality measurements
Readmission rates were an ineffective measure of a hospital’s quality because they did not take into account readmissions from different hospitals, resulting in a large number of unaccounted for readmissions, according to recent research.
“Without different-hospital readmissions data, hospitals cannot track their readmission performance accurately over time, conduct meaningful hospital comparisons, or anticipate rates that could be used to assign financial penalties,” Alisa Khan, MD, MPH, of the division of general pediatrics at Boston Children’s Hospital, and colleagues wrote. “As increasing attention is directed toward improving quality by reducing readmissions, readmissions should be enumerated accurately — namely, different-hospital readmissions should be included in readmission rate calculations.”
To identify 30-day hospital readmissions accurately, the researchers analyzed 701,263 pediatric patient discharges from 177 New York hospitals between 2005 and 2009. Discharges were monitored for same-hospital readmissions, different-hospital readmissions and all-hospital readmissions.
Data showed that of the 31,325 all-hospital readmissions recorded, 13.9% were readmissions to different hospitals within 30 days of the initial admission. This data translated to one of seven pediatric readmissions going to a different hospital. Different-hospital readmissions were most prevalent among nonchildren’s hospitals, lower-volume hospitals and urban hospitals. Patients readmitted to different hospitals within 30 days of their initial admissions were more likely to be younger, white, privately insured or have specific chronic conditions.
The researchers wrote that using only same-hospital readmissions to calculate penalties resulted in 20 of the studied hospitals receiving unwarranted penalties. They also suggested that using data sets that incorporate all-hospital readmissions would more effectively measure the quality of hospitals based on readmissions.
“Using such data sets to provide hospitals with centrally estimated readmission rates at timely intervals would allow hospitals to better assess their quality improvement efforts and anticipate rates used in accountability programs,” Khan and colleagues wrote. – by David Costill
Disclosure: The researchers report no relevant financial disclosures