Neel M. Butala, MD, MBA; Daniel B. Kramer, MD, MPH; Changyu Shen, PhD; Jordan B. Strom, MD; Kevin F. Kennedy, MS; Yun Wang, PhD; Linda R. Valsdottir, MS; Jason H. Wasfy, MD, MPhil, MS; Robert W. Yeh, MD, MSc
Disclosures: Dr. Wasfy reports grants from the National Institutes of Health during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1492.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Butala (e-mail, email@example.com). Data set: Publicly available for purchase at www.distributor.hcup-us.ahrq.gov/.
Requests for Single Reprints: Robert W. Yeh, MD, MSc, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, Suite 440, Boston, MA 02215; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Butala and Wasfy: Division of Cardiology, GRB-7, 55 Fruit Street, Boston, MA 02114.
Drs. Kramer, Shen, Strom, and Yeh and Ms. Valsdottir: Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, Suite 440, Boston, MA 02215.
Mr. Kennedy: Saint Luke's Mid America Heart Institute/UMKC, 4401 Wornall Road, Kansas City, MO 64111.
Dr. Wang: 655 Huntington Avenue, Building 1, Room 451, Boston, MA 02115.
Author Contributions: Conception and design: N.M. Butala, J.B. Strom, R.W. Yeh.
Analysis and interpretation of the data: N.M. Butala, C. Shen, J.B. Strom, K.F. Kennedy, Y. Wang, J.H. Wasfy, R.W. Yeh.
Drafting of the article: N.M. Butala, C. Shen, J.H. Wasfy, R.W. Yeh.
Critical revision for important intellectual content: N.M. Butala, D.B. Kramer, J.B. Strom, L.R. Valsdottir, J.H. Wasfy, R.W. Yeh.
Final approval of the article: N.M. Butala, D.B. Kramer, C. Shen, J.B. Strom, K.F. Kennedy, Y. Wang, L.R. Valsdottir, J.H. Wasfy, R.W. Yeh.
Statistical expertise: K.F. Kennedy, Y. Wang, J.H. Wasfy, R.W. Yeh.
Obtaining of funding: R.W. Yeh.
Administrative, technical, or logistic support: N.M. Butala, L.R. Valsdottir, J.H. Wasfy, R.W. Yeh.
Readmission rates after hospitalizations for heart failure (HF), acute myocardial infarction (AMI), and pneumonia among Medicare beneficiaries are used to assess quality and determine reimbursement. Whether these measures reflect readmission rates for other conditions or insurance groups is unknown.
To investigate whether hospital-level 30-day readmission measures for publicly reported conditions (HF, AMI, and pneumonia) among Medicare patients reflect those for Medicare patients hospitalized for unreported conditions or non-Medicare patients hospitalized with HF, AMI, or pneumonia.
Hospitals in the all-payer Nationwide Readmissions Database in 2013 and 2014.
Hospital-level 30-day all-cause risk-standardized excess readmission ratios (ERRs) were compared for 3 groups of patients: Medicare beneficiaries admitted for HF, AMI, or pneumonia (Medicare reported group); Medicare beneficiaries admitted for other conditions (Medicare unreported group); and non-Medicare beneficiaries admitted for HF, AMI, or pneumonia (non-Medicare group).
Within-hospital differences in ERRs varied widely among groups. Medicare reported ratios differed from Medicare unreported ratios by more than 0.1 for 29% of hospitals and from non-Medicare ratios by more than 0.1 for 46% of hospitals. Among hospitals with higher readmission ratios, ERRs for the Medicare reported group tended to overestimate ERRs for the non-Medicare group but underestimate those for the Medicare unreported group.
Medicare groups and risk adjustment differed slightly from those used by the Centers for Medicare & Medicaid Services.
Hospital ERRs, as estimated by Medicare to determine financial penalties, have poor agreement with corresponding measures for populations and conditions not tied to financial penalties. Current publicly reported measures may not be good surrogates for overall hospital quality related to 30-day readmissions.
Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.
Butala NM, Kramer DB, Shen C, Strom JB, Kennedy KF, Wang Y, et al. Applicability of Publicly Reported Hospital Readmission Measures to Unreported Conditions and Other Patient Populations: A Cross-sectional All-Payer Study. Ann Intern Med. 2018;168:631–639. doi: 10.7326/M17-1492
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Published: Ann Intern Med. 2018;168(9):631-639.
Published at www.annals.org on 27 March 2018
Healthcare Delivery and Policy, Hospital Medicine.
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