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- Title
Impact on hospital ranking of basing readmission measures on a composite endpoint of death or readmission versus readmissions alone.
- Authors
Glance, Laurent G.; Yue Li; Dick, Andrew W.; Li, Yue
- Abstract
<bold>Background: </bold>Readmission penalties are central to the Centers for Medicare and Medicaid Services (CMS) efforts to improve patient outcomes and reduce health care spending. However, many clinicians believe that readmission metrics may unfairly penalize low-mortality hospitals because mortality and readmission are competing risks. The objective of this study is to compare hospital ranking based on a composite outcome of death or readmission versus readmission alone.<bold>Methods: </bold>We performed a retrospective observational study of 344,565 admissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumoniae (PNEU) using population-based data from the New York State Inpatient Database (NY SID) between 2011 and 2013. Hierarchical logistic regression modeling was used to estimate separate risk-adjustment models for the (1) composite outcome (in-hospital death or readmission within 7-days), and (2) 7-day readmission. Hospital rankings based on the composite measure and the readmission measure were compared using the intraclass correlation coefficient and kappa analysis.<bold>Results: </bold>Using data from all AMI, CHF, and PNEU admissions, there was substantial agreement between hospital adjusted odds ratio (AOR) based on the composite outcome versus the readmission outcome (intraclass correlation coefficient [ICC] 0.67; 95% CI: 0.56, 0.75). For patients admitted with AMI, there was moderate agreement (ICC 0.53; 95% CI: 0.41, 0.62); for CHF, substantial agreement (ICC 0.72; 95% CI: 0.66, 0.78); and for PNEU, substantial agreement (ICC 0.71; 95% CI: 0.61, 0.78). There was moderate agreement when the composite and readmission metrics were used to classify hospitals as high, average, and low-performance hospitals (κ = 0.54, SE = 0.050). For patients admitted with AMI, there was slight agreement (κ = 0.14, SE = 0.037) between the two metrics.<bold>Conclusions: </bold>Hospital performance on readmissions is significantly different from hospital performance on a composite metric based on readmissions and mortality. CMS and policy makers should consider re-assessing the use of readmission metrics for measuring hospital performance.
- Subjects
NEW York (State); UNITED States; RATINGS of hospitals; HOSPITAL admission &; discharge; PATIENT readmissions; CONGESTIVE heart failure treatment; PNEUMONIA treatment; CENTERS for Medicare &; Medicaid Services (U.S.); MYOCARDIAL infarction-related mortality; PNEUMONIA-related mortality; COMPARATIVE studies; HEART failure; HOSPITAL care; HOSPITALS; RESEARCH methodology; MEDICAL quality control; MEDICAL cooperation; MEDICARE; RESEARCH; RISK assessment; LOGISTIC regression analysis; EVALUATION research; RETROSPECTIVE studies; HOSPITAL mortality; IMPACT of Event Scale
- Publication
BMC Health Services Research, 2017, Vol 17, p1
- ISSN
1472-6963
- Publication type
journal article
- DOI
10.1186/s12913-017-2266-4