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The performance of US hospitals as reflected in risk-standardized 30-day mortality and readmission rates for medicare beneficiaries with pneumonia

Authors

  • Peter K. Lindenauer MD MSc,

    Corresponding author
    1. Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
    2. Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
    • Center for Quality of Care Research, Baystate Medical Center, 280 Chestnut St., Springfield, MA 01199
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    • Telephone: 413 794-5422; Fax: 413 794-8866

  • Susannah M. Bernheim MD, MHS,

    1. Yale New Haven Health Services Corporation/The Center for Outcomes Research and Evaluation, New Haven, Connecticut
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  • Jacqueline N. Grady MS,

    1. Yale New Haven Health Services Corporation/The Center for Outcomes Research and Evaluation, New Haven, Connecticut
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  • Zhenqiu Lin PhD,

    1. Yale New Haven Health Services Corporation/The Center for Outcomes Research and Evaluation, New Haven, Connecticut
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  • Yun Wang PhD,

    1. Yale New Haven Health Services Corporation/The Center for Outcomes Research and Evaluation, New Haven, Connecticut
    2. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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  • Yongfei Wang MS,

    1. Yale New Haven Health Services Corporation/The Center for Outcomes Research and Evaluation, New Haven, Connecticut
    2. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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  • Angela R. Merrill PhD,

    1. Mathematica Policy Research, Inc., Cambridge, Massachusetts
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  • Lein F. Han PhD,

    1. Centers for Medicare & Medicaid Services, Baltimore, Maryland
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  • Michael T. Rapp MD, JD,

    1. Centers for Medicare & Medicaid Services, Baltimore, Maryland
    2. Section of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
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  • Elizabeth E. Drye MD, SM,

    1. Yale New Haven Health Services Corporation/The Center for Outcomes Research and Evaluation, New Haven, Connecticut
    2. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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  • Sharon-Lise T. Normand PhD,

    1. Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
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  • Harlan M. Krumholz MD, SM

    1. Yale New Haven Health Services Corporation/The Center for Outcomes Research and Evaluation, New Haven, Connecticut
    2. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
    3. Robert Wood Johnson Clinical Scholars Program, New Haven, Connecticut
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  • The analyses upon which this publication is based were performed under Contract Number HHSM-500-2008-0025I (0001), entitled “Measure & Instrument Development and Support (MIDS)-Development and Re-evaluation of the Centers for Medicare & Medicaid Services (CMS) Hospital Outcomes and Efficiency Measures,” and HHSM-500-2008-00020I (0001) entitled “Production and Implementation of Hospital Outcome and Efficiency Measures” funded by the CMS, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services. The authors assume full responsibility for the accuracy and completeness of the ideas presented.

  • Disclosure: Dr. Bernheim, Jacqueline Grady, Zhenqiu Lin, Yun Wang, Yongfei Wang, Elizabeth Drye, and Harlan Krumholz all work under contract with CMS to develop and maintain performance measures. Dr. Han and Dr. Rapp are employed by CMS.

Abstract

BACKGROUND:

Pneumonia is a leading cause of hospitalization and death in the elderly, and remains the subject of both local and national quality improvement efforts.

OBJECTIVE:

To describe patterns of hospital and regional performance in the outcomes of elderly patients with pneumonia.

DESIGN:

Cross-sectional study using hospital and outpatient Medicare claims between 2006 and 2009.

SETTING:

A total of 4,813 nonfederal acute care hospitals in the United States and its organized territories.

PATIENTS:

Hospitalized fee-for-service Medicare beneficiaries age 65 years and older who received a principal diagnosis of pneumonia.

INTERVENTION:

None.

MEASUREMENTS:

Hospital and regional level risk-standardized 30-day mortality and readmission rates.

RESULTS:

Of the 1,118,583 patients included in the mortality analysis 129,444 (11.6%) died within 30 days of hospital admission. The median (Q1, Q3) hospital 30-day risk-standardized mortality rate for patients with pneumonia was 11.1% (10.0%, 12.3%), and despite controlling for differences in case mix, ranged from 6.7% to 20.9%. Among the 1,161,817 patients included in the readmission analysis 212,638 (18.3%) were readmitted within 30 days of hospital discharge. The median (Q1, Q3) 30-day risk-standardized readmission rate was 18.2% (17.2%, 19.2%) and ranged from 13.6% to 26.7%. Risk-standardized mortality rates varied across hospital referral regions from a high of 14.9% to a low of 8.7%. Risk-standardized readmission rates varied across hospital referral regions from a high of 22.2% to a low of 15%.

CONCLUSIONS:

Risk-standardized 30-day mortality and, to a lesser extent, readmission rates for patients with pneumonia vary substantially across hospitals and regions and may present opportunities for quality improvement, especially at low performing institutions and areas. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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