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Readmission rate as an indicator of hospital performance: The case of Spain

Published online by Cambridge University Press:  01 August 2004

Alberto Jiménez-Puente ,
Javier García-Alegría ,
Jorge Gómez-Aracena ,
Luis Hidalgo-Rojas ,
Luisa Lorenzo-Nogueiras ,
Emilio Perea-Milla-López  and
Joaquín Fernández-Crehuet-Navajas
Alberto Jiménez-Puente
Affiliation:
Costa del Sol Hospital
Javier García-Alegría
Affiliation:
Costa del Sol Hospital
Jorge Gómez-Aracena
Affiliation:
Costa del Sol Hospital University of Málaga The Nordic School of Public Health
Luis Hidalgo-Rojas
Affiliation:
Costa del Sol Hospital
Luisa Lorenzo-Nogueiras
Affiliation:
Costa del Sol Hospital
Emilio Perea-Milla-López
Affiliation:
Costa del Sol Hospital
Joaquín Fernández-Crehuet-Navajas
Affiliation:
Costa del Sol Hospital University of Málaga
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Abstract

Objectives: Hospital readmission rate is currently used as a quality of care indicator, although its validity has not been established. Our aims were to identify the frequency and characteristics of potential avoidable readmissions and to compare the assessment of quality of care derived from readmission rate with other measure of quality (judgment of experts).

Methods: Design: cross-sectional observational study; Setting: acute care hospital located in Marbella, South of Spain; Study participants: random sample of patients readmitted at the hospital within six months from discharge (n=363); Interventions: review of clinical records by a pair of observers to assess the causes of readmissions and their potential avoidability; Main measures: logistic regression analysis to identify the variables from the databases of hospital discharges which are related to avoidability of readmissions. Determination of sensitivity and specificity of different definitions of readmission rate to detect avoidable situations.

Results: Nineteen percent of readmissions were considered potentially avoidable. Variables related to readmission avoidability were (i) time elapsed between index admission and readmission and (ii) difference in diagnoses of both episodes. None of the definitions of readmission rate used in this study provided adequate values of sensitivity and specificity in the identification of potentially avoidable readmissions.

Conclusions: Most readmissions in our hospital were unavoidable. Thus, readmission rate might not be considered a valid indicator of quality of care.

Keywords

Hospital readmissionsClinical outcomesQuality of care
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 3 , August 2004 , pp. 385 - 391
Copyright
© 2004 Cambridge University Press

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References

Ashton CM, Kuykendall DH, Johnson ML, et al. 1994 A method of developing and weighting explicit process of care criteria for quality assessment. Med Care. 32: 755– 770.Google Scholar
Ashton CM, Kuykendall DH, Johnson ML. 1995 The association between the quality of inpatient care and early readmission. Ann Intern Med. 122: 415– 421.Google Scholar
Ashton CM, Wray NP. 1996 A conceptual framework for the study of early readmission as an indicator of quality of care. Soc Sci Med. 43: 1533– 1541.Google Scholar
Ashton CM, Del Junco DJ, Souchek J, Wray NP, Mansyur CL. 1997 The association between the quality of inpatient care and early readmission: A meta-analysis of the evidence. Med Care. 35: 1044– 1059.Google Scholar
Ashton CM, Kuykendall DH, Johnson ML, Wray NP. 1999 An empirical assessment of the validity of explicit and implicit process-of-care criteria for quality assessment. Med Care. 37: 798– 808.Google Scholar
Bates DW, O'Neil AC, Petersen LA, Lee TH, Brennan TA. 1995 Evaluation of screening criteria for adverse events in medical patients. Med Care. 33: 452– 462.Google Scholar
Benbassat J, Taragin M. 2000 Hospital readmissions as a measure of quality of health care: Advantages and limitations. Arch Intern Med. 160: 1074– 1081.Google Scholar
Epstein AM, Bogen J, Dreyer P, Thorpe KE. 1991 Trends in length of stay and rates of readmission in Massachusetts: Implications for monitoring quality of care. Inquiry. 28: 19– 28.Google Scholar
Franklin PD, Noetscher CM, Murphy ME, Lagoe RJ. 1999 Using data to reduce hospital readmissions. J Nurs Care Qual. (Special Issue): 67– 85.Google Scholar
Goldman RL. 1992 The reliability of peer assessments of quality of care. JAMA. 267: 958– 960.Google Scholar
Hayward RA, Bernard AM, Rosevear JS, Anderson JE, McMahon LF. 1993 An evaluation of generic screens for poor quality of hospital care on a general medicine service. Med Care. 31: 394– 402.Google Scholar
Heggestad T. 2002 Do hospital length of stay and staffing ratio affect elderly patients' risk of readmission? A Nation-wide study of Norwegian hospitals. Health Serv Res. 37: 647– 665.Google Scholar
Heggestad T, Lilleeng S. 2003 Measuring readmissions: Focus on the time factor. Int J Qual Health Care. 15: 147– 154.Google Scholar
Hofer TP, Hayward RA. 1995 Can early readmission rates accurately detect poor-quality hospitals? Med Care. 33: 234– 245.Google Scholar
Hughes MR, Johnson NJ, Nemeth LS. 2000 Classifying reasons for hospital readmissions. Top Health Inf Manage. 20: 65– 74.Google Scholar
Iezzoni LI, editor. 1997. Risk adjustment for measuring healthcare outcomes. Chicago: Health Administration Press
Kosecoff J, Kahn KL, Rogers WH, et al. 1990 Prospective payment system and impairment at discharge. JAMA. 264: 1980– 1983.Google Scholar
Kossovsky MP, Sarasin FP, Perneger TV, et al. 2000 Unplanned readmissions of patients with congestive heart failure: Do they reflect in-hospital quality of care or patient characteristics? Am J Med. 109: 386– 390.Google Scholar
Krumholz HM, Parent EM, Tu N, et al. 1997 Readmissions after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 157: 99– 104.Google Scholar
Ludke RL, Booth BM, Lewis-Beck JA. 1993 Relationship between early readmission and hospital quality of care indications. Inquiry. 30: 95– 103.Google Scholar
Marcantonio ER, McKelan S, Goldfinger M, et al. 1999 Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. Am J Med. 107: 13– 17.Google Scholar
Oddone EZ, Weinberger M, Horner M, et al. 1996 Classifying general medicine readmissions: Are they preventable? J Gen Intern Med. 11: 597– 607.Google Scholar
Osman LM, Godden DJ, Friend JA, Legge JS, Douglas JG. 1997 Quality of life and hospital readmission in patients with chronic obstructive pulmonary disease. Thorax. 52: 67– 71.Google Scholar
Övretveit J, Gustafson D. 2003 Using research to inform quality programmes. BMJ. 326: 759– 761.Google Scholar
Slack R, Bucknall CE. 1997 Readmission rates are associated with differences in the process of care in acute asthma. Qual Health Care. 6: 194– 198.Google Scholar
Taroni F, Louis DZ, Yuen EJ. 1993 Outcomes management: The Italian case-mix project. In: Casas M, Wiley MM, editors. Diagnosis related groups in Europe. Berlin: Springer-Verlag: 97– 108.
Thomas JW, Holloway JJ. 1991 Investigating early readmission as an indicator for quality of care studies. Med Care. 29: 377– 394.Google Scholar
Thomas JW. 1996 Does risk-adjusted readmission rate provide valid information on hospital quality? Inquiry. 28: 258– 270.Google Scholar
Wei F, Mark D, Hartz A, Campbell C. 1995 Are PRO discharge screens associated with postdischarge adverse outcomes? Health Serv Res. 30: 489– 506.Google Scholar
Weissman JS, Ayanian JZ, Chasan-Taber S, et al. 1999 Hospital readmissions and quality of care. Med Care. 37: 490– 501.Google Scholar
Wray NP, Ashton CM, Kuykendall DH, et al. 1995 Selecting disease-outcome pairs for monitoring the quality of hospital care. Med Care. 33: 75– 89.Google Scholar
Wray NP, Peterson NJ, Souchek J, Ashton CM, Hollingsworth JC. 1997 Application of an analytic model to early readmission rates within the department of veterans affairs. Med Care. 35: 768– 781.Google Scholar