doi: 10.1161/CIRCOUTCOMES.108.802686
Original Articles |
An Administrative Claims Measure Suitable for Profiling Hospital Performance on the Basis of 30-Day All-Cause Readmission Rates Among Patients With Heart Failure
From the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, Conn (P.S.K., A.J.E., H.M.K.); Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, Mass (S.T.N.); Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Conn (Z.L., E.E.D., K.R.B., J.A.M., Y.W., H.M.K.); Departments of Geriatrics and Adult Development and Medicine, Mount Sinai School of Medicine, New York, NY, and HSR&D Targeted Research Enhancement Program and Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, NY (J.S.R.); Department of Emergency Medicine, Brigham and Women’s Hospital and Department of Medicine, Harvard Medical School, Boston, Mass (J.D.S.); Baylor University Medical Hospital System, Dallas, Tex (B.D.S.); Performance Management, Yale–New Haven Health System, New Haven, Conn (S.M.B.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (Y.-F.W., J.H., J.C., H.M.K.); Bayer Healthcare Pharmaceuticals, Wayne, NJ (J.J.F.); and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (H.M.K.). Drs Stauffer and Schuur were postdoctoral fellows in the Robert Wood Johnson Clinical Scholars Program at Yale University during the time the work was conducted. Jessica J. Federer was a Masters student at the Yale School of Public Health during the time the work was conducted.
Correspondence to Dr Harlan M. Krumholz, Yale University School of Medicine, Room I-456 SHM, 333 Cedar St, PO Box 208088, New Haven, CT 06520-8088. E-mail harlan.krumholz{at}yale.edu
Received June 26, 2008; accepted July 7, 2008.
Background— Readmission soon after hospital discharge is an expensive and often preventable event for patients with heart failure. We present a model approved by the National Quality Forum for the purpose of public reporting of hospital-level readmission rates by the Centers for Medicare & Medicaid Services.
Methods and Results— We developed a hierarchical logistic regression model to calculate hospital risk-standardized 30-day all-cause readmission rates for patients hospitalized with heart failure. The model was derived with the use of Medicare claims data for a 2004 cohort and validated with the use of claims and medical record data. The unadjusted readmission rate was 23.6%. The final model included 37 variables, had discrimination ranging from 15% observed 30-day readmission rate in the lowest predictive decile to 37% in the upper decile, and had a c statistic of 0.60. The 25th and 75th percentiles of the risk-standardized readmission rates across 4669 hospitals were 23.1% and 24.0%, with 5th and 95th percentiles of 22.2% and 25.1%, respectively. The odds of all-cause readmission for a hospital 1 standard deviation above average was 1.30 times that of a hospital 1 standard deviation below average. State-level adjusted readmission rates developed with the use of the claims model are similar to rates produced for the same cohort with the use of a medical record model (correlation, 0.97; median difference, 0.06 percentage points).
Conclusions— This claims-based model of hospital risk-standardized readmission rates for heart failure patients produces estimates that may serve as surrogates for those derived from a medical record model.
Key Words: health policy • heart failur • equality of health care
CLINICAL PERSPECTIVE
The online-only Data Supplement is available with this article at http://circoutcomes.ahajournals.org/cgi/content/full/1/1/29/DC1.
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