Readmission rates may not be an accurate measure of hospital quality if the analysis does not factor in the readmissions from other hospitals, researchers suggest in a new study.
A significant number of patients should be counted as readmissions but often are not because the prior admission was at another hospital, reports Alisa Khan, MD, MPH, of the division of general pediatrics at Boston Children’s Hospital. She and her colleagues wrote that without including readmissions data from other hospitals, a facility’s readmission performance cannot be adequately measured.
The issue is particularly important now with the growing focus on hospital comparisons and quality measures, Khan wrote. Studies find that approximately 20% of adult readmissions are to a different hospital, the research report noted. Same-hospital readmission rates underestimate mean all-hospital readmission rates by approximately 5% in adults with heart failure and those who have undergone surgery, with the degree of underestimation varying across hospitals. The researchers note that little is known about the prevalence of different-hospital readmission among pediatric patients. To evaluate the importance of including different-hospital readmission rates in pediatrics, they estimated the prevalence of 30-day pediatric different-hospital readmission, assessed the effect of different-hospital readmissions on hospitals’ estimated readmission performance, and identified patient and hospital characteristics associated with different-hospital readmission.
To identify 30-day hospital readmissions accurately, the researchers analyzed 701,263 pediatric patient discharges from 177 New York hospitals between 2005 and 2009. Discharges were monitored for same-hospital readmissions, different-hospital readmissions, and all-hospital readmissions.
Data showed that of the 31,325 all-hospital readmissions recorded, 13.9% were readmissions to different hospitals within 30 days of the initial admission, the researchers reported. These data translated to one of seven pediatric readmissions going to a different hospital. Different-hospital readmissions were most prevalent among non-children’s hospitals, lower-volume hospitals, and urban hospitals. Patients readmitted to different hospitals within 30 days of their initial admissions were more likely to be younger, white, privately insured, or have specific chronic conditions.
Using only same-hospital readmissions to calculate penalties resulted in 20 of the studied hospitals receiving unwarranted penalties, the researchers said. A better practice would be to use data sets that incorporate all-hospital readmissions, they suggested.
“Using such data sets to provide hospitals with centrally estimated readmission rates at timely intervals would allow hospitals to better assess their quality improvement efforts and anticipate rates used in accountability programs,” the researchers said.
An abstract of the study is available online at http://tinyurl.com/pbdyumb.
