Hospital Readmissions May Not Be A Good Quality Indicator

MedicalResearch.com Interview with:
Ralitza P. Parina, MPH,
Senior medical student
John Rose, MD MPH
Department of Surgery at University of California San Diego

Medical Research: What is the background for this study? What are the main findings?

Response: This study looked at the association between hospital 30-day readmission rates and 30-day mortality rates. While readmission rates are coming into increasing focus with CMS reimbursement cuts for hospitals with higher than expected rates, they remain a poorly studied metric of quality. High readmission rates have been unequivocally tied to increased costs, but it remains unclear whether they actually represent poor quality of care and worse outcomes for patients. We chose to compare readmission rates as a quality metric to the well-established “gold standard” of mortality.

We found that 85% of hospitals did not show a correlation between readmission and mortality, i.e. their rates were not both high or both low. Furthermore, among hospitals that were outliers in at least one of the measures, almost a third were in the category of low or normal readmission rates with higher than expected mortality.

The implications are twofold: first, readmission and mortality rates are not strongly correlated.
Second, focusing on readmission rates as an outcome will miss a large number of poorly performing hospitals with higher than expected mortality rates but low or expected readmissions.

Medical Research: What should clinicians and patients take away from your report?

Response: This work really has broader policy implications. While a focus on reducing readmission rates will result in cost savings, it may not be the best indicator of hospital quality. As such, it may not be the most appropriate metric to tie to reimbursement. Further research needs to be done to better characterize and attempt to resolve this discrepancy.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Future research should focus on characterizing what aspect of quality or patient care readmission rates are measuring. It has been postulated that they are a reflection of suboptimal discharge planning or a consequence of the physiological and psychological stress that occurs after hospitalization termed ‘post-hospital syndrome’.

Furthermore, we contend that development of new quality metrics should be validated by correlation to an established “gold standard”, whether mortality or another well-defined and equivocally important outcome.

Citation:

Is a Low Readmission Rate Indicative of a Good Hospital?
Journal of the American College of Surgeons

Available online 8 November 2014
Presented at the Western Surgical Association 121st Scientific Session, Salt Lake City, UT, November 2013

Ralitza P. Parina, MPH,David C. Chang, PhD, MPH, MBA, John Rose, MD MPH Mark A. Talamini, MD, FACS

(david chang)

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