Validation of the Potentially Avoidable Hospital Readmission Rate as a Routine Indicator of the Quality of Hospital Care

Abstract

Background:The hospital readmission rate has been proposed as an important outcome indicator computable from routine statistics. However, most commonly used measures raise conceptual issues. Objectives: We sought to evaluate the usefulness of the computerized algorithm for identifying avoidable readmissions on the basis of minimum bias, criterion validity, and measurement precision. Research Design and Subjects: A total of 131,809 hospitalizations of patients discharged alive from 49 hospitals were used to compare the predictive performance of risk adjustment methods. A subset of a random sample of 570 medical records of discharge/readmission pairs in 12 hospitals were reviewed to estimate the predictive value of the screening of potentially avoidable readmissions. Measures: Potentially avoidable readmissions, defined as readmissions related to a condition of the previous hospitalization and not expected as part of a program of care and occurring within 30 days after the previous discharge, were identified by a computerized algorithm. Unavoidable readmissions were considered as censored events. Results: A total of 5.2% of hospitalizations were followed by a potentially avoidable readmission, 17% of them in a different hospital. The predictive value of the screen was 78%; 27% of screened readmissions were judged clearly avoidable. The correlation between the hospital rate of clearly avoidable readmission and all readmissions rate, potentially avoidable readmissions rate or the ratio of observed to expected readmissions were respectively 0.42, 0.56 and 0.66. Adjustment models using clinical information performed better. Conclusion: Adjusted rates of potentially avoidable readmissions are scientifically sound enough to warrant their inclusion in hospital quality surveillance.

Incidence of Severe Adverse Neonatal Outcomes: Use of a Composite Indicator in a Population Cohort

“…The composite neonatal adverse outcome indicator is a reliable population measure of severe neonatal morbidity utilizing routinely collected data that can easily be applied by other users of population health databases which is an important feature of an indicator (34). The NAOI, along with the maternal morbidity outcome indicator (18), can also be used to monitor the quality of obstetric and neonatal care in a uniform and cost-effective way.…”

A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital

“…5 It has been reported that a lower quality of inpatient care increases the risk for unplanned early readmission in patients with heart failure, diabetes, or obstructive lung disease, 6 and a recent study concluded that adjusted rates of potentially avoidable readmissions are scientifically sound enough to warrant their inclusion in hospital quality surveillance. 7 On the other hand, another detailed analysis argued that it is difficult to conclude if early readmission is a valid and useful quality indicator. 8 However, overall there is support for readmission rates being used as a surrogate for quality of care delivered in hospitals.…”

Visit Entropy Associated with Hospital Readmission Rates

“…1 Unplanned readmissions have often been considered a marker for poor quality inpatient care or ineffective hospital-to-home transitions. [2][3][4][5][6][7] Various interventions using pharmacists and advance-practice nurses have been shown to assist patients with the transition process and reduce readmissions. [7][8][9][10] A patient centered medical home provides a natural foundation on which to support the transition of patients from hospital to outpatient care.…”