Challenges in evaluating all-cause hospital readmission measures for use as national consensus standards

The National Quality Forum (NQF) aims to improve the quality of health care for all Americans through fulfillment of its three-part mission. The NQF uses its formal Consensus Development Process to evaluate and endorse consensus standards, including performance measures, best practices, frameworks, and reporting guidelines.

To understand the opportunities and challenges in endorsing measures addressing all-cause readmissions to hospitals for use as national voluntary consensus standards for accountability and quality-improvement purposes.

Report of standards development process.

The Consensus Development Process was used to evaluate 3 candidate standards using the NQF Measure Evaluation Criteria. A 21-member steering committee rated each standard according to the criteria and made initial endorsement recommendations for all measures.

Through the evaluation of measures for endorsement, several overarching issues in measuring all-cause readmissions were identified, including statistical modeling and the usability of the measures for quality improvement and accountability. Additionally, it was decided that, for the first time, quality monitoring and accountability of readmissions will take place at the health-plan level. Measuring at various levels of accountability reinforces the idea that multiple stakeholders have a responsibility and a role to reduce readmissions.

These NQF-endorsed measures are a major step in promoting better understanding of readmissions and a reduction in hospital readmission rates, when appropriate. These measures can help reduce the substantial financial and emotional stress that readmissions place on the health care system, and patients will be able to communicate hospital-level performance on this important quality indicator.