TY - JOUR
T1 - Limitations of using same-hospital readmission metrics
AU - Davies, Sheryl M.
AU - Saynina, Olga
AU - Mcdonald, Kathryn M.
AU - Baker, Laurence C.
N1 - Funding Information:
This work was supported by a grant from the Gordon and Betty Moore Foundation Grant No. 1983 and NIA Grants No. AG017253 and AG024957. We take sole responsibility for the design and conduct of the study; collection, management, analysis and interpretation of the data and preparation, review and approval of the manuscript.
PY - 2013/12
Y1 - 2013/12
N2 - Objective. To quantify the limitations associated with restricting readmission metrics to same-hospital only readmission. Design. Using 2000-2009 California Office of Statewide Health Planning and Development Patient Discharge Data Nonpublic file, we identified the proportion of 7-, 15-and 30-day readmissions occurring to the same hospital as the initial admission using All-cause Readmission (ACR) and 3M Corporation Potentially Preventable Readmissions (PPR) Metric. We examined the correlation between performance using same and different hospital readmission, the percent of hospitals remaining in the extreme deciles when utilizing different metrics, agreement in identifying outliers and differences in longitudinal performance. Using logistic regression, we examined the factors associated with admission to the same hospital. Results. 68% of 30-day ACR and 70% of 30-day PPR occurred to the same hospital. Abdominopelvic procedures had higher proportions of same-hospital readmissions (87.4-88.9%), cardiac surgery had lower (72.5-74.9%) and medical DRGs were lower than surgical DRGs (67.1 vs. 71.1%). Correlation and agreement in identifying high-and low-performing hospitals was weak to moderate, except for 7-day metrics where agreement was stronger (r = 0.23-0.80, Kappa = 0.38-0.76). Agreement for withinhospital significant (P < 0.05) longitudinal change was weak (Kappa = 0.05-0.11). Beyond all patient refined-diagnostic related groups, payer was the most predictive factor with Medicare and MediCal patients having a higher likelihood of same-hospital readmission (OR 1.62, 1.73). Conclusions. Same-hospital readmission metrics are limited for all tested applications. Caution should be used when conducting research, quality improvement or comparative applications that do not account for readmissions to other hospitals.
AB - Objective. To quantify the limitations associated with restricting readmission metrics to same-hospital only readmission. Design. Using 2000-2009 California Office of Statewide Health Planning and Development Patient Discharge Data Nonpublic file, we identified the proportion of 7-, 15-and 30-day readmissions occurring to the same hospital as the initial admission using All-cause Readmission (ACR) and 3M Corporation Potentially Preventable Readmissions (PPR) Metric. We examined the correlation between performance using same and different hospital readmission, the percent of hospitals remaining in the extreme deciles when utilizing different metrics, agreement in identifying outliers and differences in longitudinal performance. Using logistic regression, we examined the factors associated with admission to the same hospital. Results. 68% of 30-day ACR and 70% of 30-day PPR occurred to the same hospital. Abdominopelvic procedures had higher proportions of same-hospital readmissions (87.4-88.9%), cardiac surgery had lower (72.5-74.9%) and medical DRGs were lower than surgical DRGs (67.1 vs. 71.1%). Correlation and agreement in identifying high-and low-performing hospitals was weak to moderate, except for 7-day metrics where agreement was stronger (r = 0.23-0.80, Kappa = 0.38-0.76). Agreement for withinhospital significant (P < 0.05) longitudinal change was weak (Kappa = 0.05-0.11). Beyond all patient refined-diagnostic related groups, payer was the most predictive factor with Medicare and MediCal patients having a higher likelihood of same-hospital readmission (OR 1.62, 1.73). Conclusions. Same-hospital readmission metrics are limited for all tested applications. Caution should be used when conducting research, quality improvement or comparative applications that do not account for readmissions to other hospitals.
KW - Hospital quality
KW - Quality indicators
KW - Readmissions
UR - http://www.scopus.com/inward/record.url?scp=84896918034&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84896918034&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzt068
DO - 10.1093/intqhc/mzt068
M3 - Article
C2 - 24167061
AN - SCOPUS:84896918034
SN - 1353-4505
VL - 25
SP - 633
EP - 639
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 6
M1 - mzt068
ER -