Implications of Metric Choice for Common Applications of Readmission Metrics
Article first published online: 6 JUN 2013
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 6pt1, pages 1978–1995, December 2013
How to Cite
Davies, S., Saynina, O., Schultz, E., McDonald, K. M. and Baker, L. C. (2013), Implications of Metric Choice for Common Applications of Readmission Metrics. Health Services Research, 48: 1978–1995. doi: 10.1111/1475-6773.12075
- Issue published online: 26 NOV 2013
- Article first published online: 6 JUN 2013
- Gordon and Betty Moore Foundation. Grant Number: 1983
- National Institute on Aging. Grant Number: Ago17253
- Administrative data uses;
- quality of care
To quantify the differential impact on hospital performance of three readmission metrics: all-cause readmission (ACR), 3M Potential Preventable Readmission (PPR), and Centers for Medicare and Medicaid 30-day readmission (CMS).
2000–2009 California Office of Statewide Health Planning and Development Patient Discharge Data Nonpublic file.
We calculated 30-day readmission rates using three metrics, for three disease groups: heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Using each metric, we calculated the absolute change and correlation between performance; the percent of hospitals remaining in extreme deciles and level of agreement; and differences in longitudinal performance.
Average hospital rates for HF patients and the CMS metric were generally higher than for other conditions and metrics. Correlations between the ACR and CMS metrics were highest (r = 0.67–0.84). Rates calculated using the PPR and either ACR or CMS metrics were moderately correlated (r = 0.50–0.67). Between 47 and 75 percent of hospitals in an extreme decile according to one metric remained when using a different metric. Correlations among metrics were modest when measuring hospital longitudinal change.
Different approaches to computing readmissions can produce different hospital rankings and impact pay-for-performance. Careful consideration should be placed on readmission metric choice for these applications.