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Hospital readmission by method of data collection
Elizabeth M Hechenbleikner1, Martin A Makary, Daniel V Samarov
1Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, USA.
Journal of the American College of Surgeons
|April 16, 2013
Summary
Hospital readmission rates and potentially unnecessary readmissions for surgical patients differ based on data collection methods. Standardized, fair methods are crucial for accurate hospital reimbursement and to avoid penalizing appropriate care.
Area of Science:
- Healthcare Quality
- Surgical Outcomes
- Health Services Research
Background:
- Hospital readmissions are increasingly utilized as a performance metric for healthcare reimbursement.
- Variations in data collection methods may influence reported readmission rates and their perceived necessity.
- This study investigates how different data collection methods impact the assessment of surgical patient readmissions.
Purpose of the Study:
- To compare 30-day unplanned readmission rates and potentially unnecessary readmissions among colorectal surgery patients using three distinct data collection methods.
- To determine if readmission rates, relatedness to the index admission, and potential preventability vary by data collection methodology.
Main Methods:
- A retrospective review of 735 colorectal surgery patients between July 2009 and November 2011 at a single institution.
- Comparison of readmission data collected via the NSQIP clinical reviewer method, University HealthSystem Consortium (UHC) administrative billing data, and physician medical record review.
- Analysis of 30-day unplanned readmissions, readmission relatedness, and potentially unnecessary readmissions.
Main Results:
- Readmission rates varied: NSQIP (14.6%) vs. UHC (17.6%).
- Discrepancies in readmission identification occurred due to differing definitions and data sources (e.g., out-of-hospital readmissions).
- The proportion of readmissions deemed related to the index admission and potentially preventable differed significantly across methods, with physician review identifying higher rates of clinical necessity.
Conclusions:
- Data collection methodology significantly impacts reported hospital readmission rates and the assessment of potentially unnecessary readmissions.
- Standardized and equitable data collection methods are essential for accurate hospital reimbursement.
- Fair reimbursement policies should account for variations in data collection to avoid penalizing hospitals for appropriate care of high-risk surgical patients.
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