Readmission penalties are central to the Facilities for Medicare and Medicaid Providers (CMS) efforts to enhance affected person outcomes and scale back well being care spending. Nonetheless, many clinicians imagine that readmission metrics could unfairly penalize low-mortality hospitals as a result of mortality and readmission are competing dangers. The target of this examine is to check hospital rating primarily based on a composite consequence of dying or readmission versus readmission alone.
We carried out a retrospective observational examine of 344,565 admissions for acute myocardial infarction (AMI), congestive coronary heart failure (CHF), or pneumoniae (PNEU) utilizing population-based knowledge from the New York State Inpatient Database (NY SID) between 2011 and 2013. Hierarchical logistic regression modeling was used to estimate separate risk-adjustment fashions for the (1) composite consequence (in-hospital dying or readmission inside 7-days), and (2) 7-day readmission. Hospital rankings primarily based on the composite measure and the readmission measure had been in contrast utilizing the intraclass correlation coefficient and kappa evaluation.
Utilizing knowledge from all AMI, CHF, and PNEU admissions, there was substantial settlement between hospital adjusted odds ratio (AOR) primarily based on the composite consequence versus the readmission consequence (intraclass correlation coefficient [ICC] 0.67; 95% CI: 0.56, 0.75). For sufferers admitted with AMI, there was average settlement (ICC 0.53; 95% CI: 0.41, 0.62); for CHF, substantial settlement (ICC 0.72; 95% CI: 0.66, 0.78); and for PNEU, substantial settlement (ICC 0.71; 95% CI: 0.61, 0.78). There was average settlement when the composite and readmission metrics had been used to categorise hospitals as excessive, common, and low-performance hospitals (κ = 0.54, SE = 0.050). For sufferers admitted with AMI, there was slight settlement (κ = 0.14, SE = 0.037) between the 2 metrics.
Hospital efficiency on readmissions is considerably totally different from hospital efficiency on a composite metric primarily based on readmissions and mortality. CMS and coverage makers ought to contemplate re-assessing using readmission metrics for measuring hospital efficiency.
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