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Article
Hospital Performance Measures and 30-day Readmission Rates
Meyers Primary Care Institute Publications and Presentations
  • Mihaela S. Stefan, Baystate Medical Center
  • Penelope S. Pekow, University of Amherst
  • Wato Nsa, Oklahoma Foundation for Medical Quality
  • Aruna Priya, Baystate Medical Center
  • Lauren E. Miller, Oklahoma Foundation for Medical Quality
  • Dale W. Bratzler, University of Oklahoma
  • Michael B. Rothberg, Tufts University
  • Robert J. Goldberg, University of Massachusetts Medical School
  • Kristie Baus, Center for Medicare and Medicaid Services
  • Peter K. Lindenauer, Baystate Medical Center
UMMS Affiliation
Department of Quantitative Health Sciences; Meyers Primary Care Institute
Date
10-16-2012
Document Type
Article
Medical Subject Headings
Patient Readmission; Quality of Health Care; Medicare; Delivery of Health Care; Hospitals
Abstract
BACKGROUND: Lowering hospital readmission rates has become a primary target for the Centers for Medicare and Medicaid Services, but studies of the relationship between adherence to the recommended hospital care processes and readmission rates have provided inconsistent and inconclusive results. OBJECTIVE: To examine the association between hospital performance on Medicare's Hospital Compare process quality measures and 30-day readmission rates for patients with acute myocardial infarction (AMI), heart failure and pneumonia, and for those undergoing major surgery. DESIGN, SETTING AND PARTICIPANTS: We assessed hospital performance on process measures using the 2007 Hospital Inpatient Quality Reporting Program. The process measures for each condition were aggregated in two separate measures: Overall Measure (OM) and Appropriate Care Measure (ACM) scores. Readmission rates were calculated using Medicare claims. MAIN OUTCOME MEASURE: Risk-standardized 30-day all-cause readmission rate was calculated as the ratio of predicted to expected rate standardized by the overall mean readmission rate. We calculated predicted readmission rate using hierarchical generalized linear models and adjusting for patient-level factors. RESULTS: Among patients aged >/= 66 years, the median OM score ranged from 79.4 % for abdominal surgery to 95.7 % for AMI, and the median ACM scores ranged from 45.8 % for abdominal surgery to 87.9 % for AMI. We observed a statistically significant, but weak, correlation between performance scores and readmission rates for pneumonia (correlation coefficient R = 0.07), AMI (R = 0.10), and orthopedic surgery (R = 0.06). The difference in the mean readmission rate between hospitals in the 1st and 4th quartiles of process measure performance was statistically significant only for AMI (0.25 percentage points) and pneumonia (0.31 percentage points). Performance on process measures explained less than 1 % of hospital-level variation in readmission rates. CONCLUSIONS: Hospitals with greater adherence to recommended care processes did not achieve meaningfully better 30-day hospital readmission rates compared to those with lower levels of performance.
Comments

Citation: J Gen Intern Med. 2012 Oct 16. Link to article on publisher's site

Related Resources
Link to Article in PubMed
PubMed ID
23070655
Citation Information
Mihaela S. Stefan, Penelope S. Pekow, Wato Nsa, Aruna Priya, et al.. "Hospital Performance Measures and 30-day Readmission Rates" (2012) ISSN: 0884-8734 (Linking)
Available at: http://works.bepress.com/mihaela_stefan/13/