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  • Measure Summary
  • NQMC:011301
  • Mar 2017
  • NQF-Endorsed Measure

Hospital-wide readmission (HWR): hospital 30-day, all-cause, unplanned risk-standardized readmission rate (RSRR) following hospitalization.

Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). 2017 all-cause hospital-wide measure updates and specifications report. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017 Mar. 69 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

Primary Measure Domain

Related Health Care Delivery Measures: Use of Services

Secondary Measure Domain

Does not apply to this measure

Description

This measure estimates a hospital-level 30-day risk-standardized readmission rate (RSRR) for patients discharged from the hospital after admission for any eligible condition. The outcome is defined as unplanned readmission for any cause within 30 days of the discharge date for the index admission. A specified set of planned readmissions do not count as readmissions.

The measure reports a single summary RSRR, derived from the volume-weighted hospital-level standardized risk ratios (SRRs) for the five specialty cohorts based on groups of related discharge condition categories or procedure categories: surgery/gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology.

The Centers for Medicare & Medicaid Services (CMS) annually reports the measure for individuals who are 65 years and older and are Medicare Fee-for-Service (FFS) beneficiaries hospitalized in non-federal short-term acute care hospitals (including Indian Health Services hospitals) and critical access hospitals.

Rationale

Readmission following hospitalization is a costly and often preventable event. While it is helpful to assess readmission rates for specific groups of patients, these conditions account for only a small proportion of total readmissions. By contrast, a hospital-wide, all-condition readmission measure could provide a broader assessment of the quality of care at hospitals. Therefore, the Centers for Medicare & Medicaid Services (CMS) has contracted with Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE) to develop a claims-based, risk-adjusted hospital-wide readmission (HWR) measure for public reporting that reflects the quality of care for hospitalized patients in the United States.

Hospital readmission, for any reason, is disruptive to patients and caregivers, costly to the healthcare system, and puts patients at additional risk of hospital-acquired infections and complications. Readmissions are also a major source of patient and family stress and may contribute substantially to loss of functional ability, particularly in older patients.

Some readmissions are unavoidable and result from inevitable progression of disease or worsening of chronic conditions. However, readmissions may also result from poor quality of care or inadequate transitional care. Transitional care includes effective discharge planning, transfer of information at the time of discharge, patient assessment and education, and coordination of care and monitoring in the post-discharge period.

Given that studies have shown readmissions within 30 days to be related to quality of care, that interventions have been able to reduce 30-day readmission rates for a variety of specific conditions, and that high and variable readmission rates indicate opportunity for improvement, it is reasonable to consider an all-condition 30-day readmission rate as a quality measure.

Evidence for Rationale

Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). 2017 all-cause hospital-wide measure updates and specifications report. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017 Mar. 69 p.

Primary Health Components

30-day hospital-wide all-cause unplanned readmission rate

Denominator Description

The measure cohort consists of admissions for Medicare Fee-for-Service (FFS) beneficiaries aged 65 years and older and discharged from non-federal acute care hospitals and critical access hospitals.

Admissions are assigned to one of five mutually exclusive specialty cohort groups consisting of related conditions or procedures. For each specialty cohort group, the standardized readmission ratio (SRR) is calculated as the ratio of the number of "predicted" readmissions to the number of "expected" readmissions at a given hospital. For each hospital, the denominator is the number of readmissions expected based on the nation's performance with that hospital's case mix and service mix.

See the related "Denominator Inclusions/Exclusions" field.

Note: This outcome measure does not have a traditional numerator and denominator like a core process measure; thus, this field is used to define the measure cohort.

See the 2017 All-cause Hospital-wide Measure Updates and Specifications Report: Hospital-level 30-day Risk-standardized Readmission Measure External Web Site Policy for more details.

Numerator Description

This measure counts all unplanned readmissions to an acute care hospital, from any cause, within 30 days from the date of discharge from an index admission.

For each specialty cohort group, the standardized readmission ratio (SRR) is calculated as the ratio of the number of "predicted" readmissions to the number of "expected" readmissions at a given hospital. For each hospital, the numerator of the ratio is the number of readmissions within 30 days predicted based on the hospital's performance with its observed case mix and service mix.

See the related "Numerator Inclusions/Exclusions" field.

Note: This outcome measure does not have a traditional numerator and denominator like a core process measure; thus, this field is used to define the measure cohort.

See the 2017 All-cause Hospital-wide Measure Updates and Specifications Report: Hospital-level 30-day Risk-standardized Readmission Measure External Web Site Policy for more details.

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Many care processes can influence readmission risk. In general, randomized controlled trials have shown that improvement in the following areas can directly reduce readmission rates: quality of care during the initial admission; improvement in communication with patients, their caregivers, and their clinicians; patient education; predischarge assessment; and coordination of care after discharge. Evidence that hospitals have been able to reduce readmission rates through these quality-of-care initiatives illustrates the degree to which hospital practices can affect readmission rates. Successful randomized trials have reduced 30-day readmission rates by 20% to 40% (Jack et al., 2009; Coleman et al., 2004; Courtney et al., 2009; Garasen, Windspoll, & Johnsen, 2007; Koehler et al., 2009; Mistiaen, Francke, & Poot, 2007; Naylor et al., 1994; Naylor et al., 1999; van Walraven et al., 2002; Weiss, Yakusheva, & Bobay, 2010; Krumholz et al., 2002). Since 2008, 14 Medicare Quality Improvement Organizations have been funded to focus on care transitions, applying lessons learned from clinical trials. Several have been notably successful in reducing readmissions. The strongest evidence supporting the efficacy of improved discharge processes and enhanced care at transitions is a randomized controlled trial by the Project RED (Re-Engineered Discharge) intervention, in which a nurse was assigned to each patient as a discharge advocate, responsible for patient education, follow-up, medication reconciliation, and preparing individualized discharge instructions sent to the patient's primary care provider and there was a follow-up phone call from a pharmacist within 4 days of discharge demonstrated a 30% reduction in 30-day readmissions (Jack et al., 2009). Hospital processes that reflect the quality of inpatient and outpatient care such as discharge planning, medication reconciliation, and coordination of outpatient care have been shown to reduce readmission rates (Nelson, Maruish, & Axler, 2000). Although readmission rates are also influenced by hospital system characteristics, such as the bed capacity of the local health care system, these hospital characteristics should not influence quality of care (Fisher et al., 1994). Therefore, this measure does not risk adjust for such hospital characteristics.

Studies have estimated the rate of preventable readmissions to be as low as 12% and as high as 76% (Benbassat & Taragin, 2000; Medicare Payment Advisory Commission [MedPAC], 2000). Given that studies have shown readmissions to be related to quality of care, and that interventions have been able to reduce 30-day readmission rates, it is reasonable to consider an all-condition readmission rate as a quality measure.

The hospital-wide risk-standardized readmission rate (RSRR) measure is thus intended to inform quality-of-care improvement efforts, as individual process-based performance measures cannot encompass all the complex and critical aspects of care within a hospital that contribute to patient outcomes. As a result, many stakeholders, including patient organizations, are interested in outcomes measures that allow patients and providers to assess relative outcomes performance for hospitals.

Evidence for Additional Information Supporting Need for the Measure

Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch Intern Med. 2000 Apr 24;160(8):1074-81. PubMed External Web Site Policy

Coleman EA, Smith JD, Frank JC, Min SJ, Parry C, Kramer AM. Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention. J Am Geriatr Soc. 2004 Nov;52(11):1817-25. PubMed External Web Site Policy

Courtney M, Edwards H, Chang A, Parker A, Finlayson K, Hamilton K. Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. J Am Geriatr Soc. 2009 Mar;57(3):395-402. PubMed External Web Site Policy

Fisher ES, Wennberg JE, Stukel TA, Sharp SM. Hospital readmission rates for cohorts of Medicare beneficiaries in Boston and New Haven. N Engl J Med. 1994 Oct 13;331(15):989-95. PubMed External Web Site Policy

Garasen H, Windspoll R, Johnsen R. Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial. BMC Public Health. 2007 May 2;7:68. PubMed External Web Site Policy

Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O'Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009 Feb 3;150(3):178-87. PubMed External Web Site Policy

Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, Masica AL. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009 Apr;4(4):211-8. PubMed External Web Site Policy

Krumholz HM, Amatruda J, Smith GL, Mattera JA, Roumanis SA, Radford MJ, Crombie P, Vaccarino V. Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol. 2002 Jan 2;39(1):83-9. PubMed External Web Site Policy

Medicare Payment Advisory Commission (MedPAC). Report to the Congress: promoting greater efficiency in Medicare. Washington (DC): Medicare Payment Advisory Commission (MedPAC); 2007 Jun. 277 p.

Mistiaen P, Francke AL, Poot E. Interventions aimed at reducing problems in adult patients discharged from hospital to home: a systematic meta-review. BMC Health Serv Res. 2007;7:47. [111 references] PubMed External Web Site Policy

Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M. Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial. Ann Intern Med. 1994 Jun 15;120(12):999-1006. PubMed External Web Site Policy

Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999 Feb 17;281(7):613-20. PubMed External Web Site Policy

Nelson EA, Maruish ME, Axler JL. Effects of discharge planning and compliance with outpatient appointments on readmission rates. Psychiatr Serv. 2000 Jul;51(7):885-9. PubMed External Web Site Policy

van Walraven C, Seth R, Austin PC, Laupacis A. Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med. 2002 Mar;17(3):186-92. PubMed External Web Site Policy

Weiss M, Yakusheva O, Bobay K. Nurse and patient perceptions of discharge readiness in relation to postdischarge utilization. Med Care. 2010 May;48(5):482-6. PubMed External Web Site Policy

Extent of Measure Testing

Assessment of Updated Models

The hospital-wide readmission (HWR) measure estimates hospital-specific 30-day all-cause risk-standardized readmission rates (RSRRs) using a hierarchical logistic regression model. Refer to Section 2 in the original measure documentation for a summary of the measure methodology and model risk-adjustment variables. Refer to prior methodology and technical reports for further details.

The Centers for Medicare & Medicaid Services (CMS) evaluated and validated the performance of the models, using the July 1, 2015 to June 30, 2016 data for the 2017 reporting period. They examined the differences in the frequencies of patient risk factors and the model variable coefficients by specialty cohort.

For each of the specialty cohorts, CMS assessed logistic regression model performance in terms of discriminant ability for the July 1, 2015 to June 30, 2016 period. They computed two summary statistics to assess model performance: the predictive ability and the area under the receiver operating characteristic (ROC) curve (c-statistic). The results of these analyses are presented in Section 4.2 in the original measure documentation.

Hospital Wide Readmission (HWR) 2017 Model Results

HWR Specialty Cohort Model Parameters and Performance

Table 4.2.1, Table 4.2.2, Table 4.2.3, Table 4.2.4, and Table 4.2.5 in the original measure documentation show the specialty cohort-level frequency of risk factors, risk-adjusted odds ratios (ORs) and 95% confidence intervals, and hierarchical logistic regression model variable coefficients and standard errors (SEs) for the July 1, 2015 to June 30, 2016 data sample. Table 4.2.6 in the original measure documentation presents the cohort-level model performance. Table 4.2.7 in the original measure documentation presents the number of index hospitalizations and observed readmission rates for each specialty cohort.

Refer to the original measure documentation for additional information.

Evidence for Extent of Measure Testing

Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). 2017 all-cause hospital-wide measure updates and specifications report. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017 Mar. 69 p.

State of Use

Current routine use

Current Use

Collaborative inter-organizational quality improvement

External oversight/Medicare

Monitoring and planning

Pay-for-reporting

Public reporting

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age greater than or equal to 65 years

Target Population Gender

Either male or female

IOM Care Need

Not within an IOM Care Need

IOM Domain

Not within an IOM Domain

Case Finding Period

Discharges July 1, 2015 through June 30, 2016

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Institutionalization

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window precedes index event

Denominator Inclusions/Exclusions

Inclusions
An index admission is the hospitalization to which the readmission outcome is attributed and includes admissions for patients:

  • Enrolled in Medicare Fee-for-Service (FFS) Part A for the 12 months prior to the date of admission, and during the index admission
  • Aged 65 or over
  • Discharged alive from a non-federal short-term acute care hospital
  • Not transferred to another acute care facility

Refer to the original measure documentation for International Classification of Diseases, Tenth Revision (ICD-10) codes used to define the specialty cohorts and cohort exclusions for discharges on or after October 1, 2015. International Classification of Diseases, Ninth Revision (ICD-9) code lists for discharges prior to October 1, 2015 can be found in the 2016 All-Cause Hospital-Wide Measure Updates and Specifications Report: Hospital-Level 30-Day Risk-Standardized Readmission Measure External Web Site Policy.

    Exclusions

    • Admitted to Prospective Payment System (PPS)-exempt cancer hospitals
    • Without at least 30 days of post-discharge enrollment in Medicare FFS
    • Discharged against medical advice
    • Admitted for primary psychiatric diagnoses
    • Admitted for rehabilitation
    • Admitted for medical treatment of cancer

    Exclusions/Exceptions

    Does not apply to this measure

    Numerator Inclusions/Exclusions

    Inclusions
    This measure assesses unplanned readmissions, from any cause, within 30 days from the date of discharge from an index admission.

    If a patient has more than one unplanned admission within 30 days of discharge from the index admission, only the first is considered a readmission. The measure assesses a dichotomous yes or no outcome of whether each admitted patient has any unplanned readmission within 30 days. If the first readmission after discharge is planned, any subsequent unplanned readmission is not considered in the outcome for that index admission because the unplanned readmission could be related to care provided during the intervening planned readmission rather than during the index admission.

    Admissions are assigned to one of five mutually exclusive specialty cohort groups consisting of related conditions or procedures. For each specialty cohort group, the standardized readmission ratio (SRR) is calculated as the ratio of the number of "predicted" readmissions to the number of "expected" readmissions at a given hospital. For each hospital, the numerator of the ratio is the number of readmissions within 30 days predicted based on the hospital's performance with its observed case mix and service mix.

    Note: This outcome measure does not have a traditional numerator and denominator like a core process measure; thus, this field is used to define the outcome.

    See the 2017 All-cause Hospital-wide Measure Updates and Specifications Report: Hospital-level 30-day Risk-standardized Readmission Measure External Web Site Policy for more details.

    Exclusions
    Admissions identified as planned by the planned readmissions algorithm are not counted as readmissions. The planned readmission algorithm is a set of criteria for classifying readmissions and planned among the general Medicare population using Medicare administrative claims data. The algorithm identified admissions that are typically planned and may occur within 30 days of discharge from the hospital.

    The planned readmission algorithm has three fundamental principles:

    1. A few specific, limited types of care are always considered planned (transplant surgery, maintenance chemotherapy/immunotherapy, rehabilitation);
    2. Otherwise, a planned readmission is defined as a non-acute readmission for a scheduled procedure; and
    3. Admissions for acute illness or for complications of care are never planned

    The planned readmission algorithm uses a flow chart and four tables of specific procedure categories and discharge diagnosis categories to classify readmissions as planned. The flow chart and tables are available in the 2017 All-cause Hospital-wide Measure Updates and Specifications Report: Hospital-level 30-day Risk-standardized Readmission Measure External Web Site Policy.

    Numerator Search Strategy

    Institutionalization

    Data Source

    Administrative clinical data

    Type of Health State

    Proxy for Outcome

    Instruments Used and/or Associated with the Measure

    • Hospital Wide Readmission (HWR) Flow Diagram of Inclusion and Exclusion Criteria and Specialty Cohort Assignment for the Index Admission
    • Planned Readmission Algorithm Version 4.0 (ICD-10) Flowchart

    Measure Specifies Disaggregation

    Does not apply to this measure

    Scoring

    Rate/Proportion

    Interpretation of Score

    Desired value is a lower score

    Allowance for Patient or Population Factors

    Analysis by subgroup (stratification by individual factors, geographic factors, etc.)

    Case-mix adjustment

    Risk adjustment devised specifically for this measure/condition

    Description of Allowance for Patient or Population Factors

    Risk-Adjustment Variables

    In order to account for differences in case mix among hospitals, the measure adjusts for variables (that is, age and comorbid diseases) that are clinically relevant and have relationships with the outcome. Case mix differences among hospitals are based on the clinical status of the patient at the time of the index admission. Accordingly, only comorbidities that convey information about the patient at that time or in the 12 months prior, and not complications that arise during the course of the hospitalization, are included in the risk adjustment.

    In order to account for differences in service mix among hospitals, the measure adjusts for the principal discharge diagnosis of the index admission (grouped into Agency for Healthcare Research and Quality [AHRQ] clinical classification software [CCS] diagnosis categories). Thus, for the cardiorespiratory, cardiovascular, neurology, and medicine specialty cohorts, the AHRQ CCS diagnosis categories used for risk adjustment are the same as those used to define each of these cohorts (refer to Table D.4, Table D.5, Table D.6, and Table D.7 in the original measure documentation). For the surgery/gynecology cohort, which is defined by AHRQ CCS procedure categories, the AHRQ CCS diagnosis category used for risk adjustment is simply the AHRQ CCS diagnosis category that the principal discharge diagnosis for that surgical admission falls into.

    For each patient, risk-adjustment variables are obtained from inpatient Medicare administrative claims data extending 12 months prior to, and including, the index admission.

    The measure does not adjust for socioeconomic status (SES) because the association between SES and health outcomes can be due, in part, to differences in the quality of health care that groups of patients with varying SES receive. The intent is for the measure to adjust for age and clinical characteristics while illuminating important quality differences. As part of the NQF's endorsement process for this measure, the Centers for Medicare & Medicaid Services (CMS) completed analyses for the two-year Sociodemographic Trial Period. Although univariate analyses found that the patient-level observed (unadjusted) readmission rate is higher for dual-eligible patients (for patients living in lower AHRQ SES Index census block groups) and African-American patients compared with all other patients, analyses in the context of a multivariable model demonstrated that the effect size of these variables was small, and that the c-statistics for the model are similar with and without the addition of these variables.

    Refer to Appendix D of the original measure documentation for the list of comorbidity risk-adjustment variables common to all specialty cohorts and the list of complications that are excluded from risk adjustment if they occur during the index admission.

    Standard of Comparison

    External comparison at a point in, or interval of, time

    External comparison of time trends

    Internal time comparison

    Original Title

    Hospital-wide all-cause unplanned readmission.

    Measure Collection Name

    National Hospital Inpatient Quality Measures

    Measure Set Name

    Readmission Measures

    Submitter

    Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

    Developer

    Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

    Yale-New Haven Health Services Corporation/Center for Outcomes Research and Evaluation under contract to Centers for Medicare & Medicaid Services - Academic Affiliated Research Institute

    Funding Source(s)

    Centers for Medicare & Medicaid Services (CMS)

    Composition of the Group that Developed the Measure

    This measure was developed by a team of experts:

    • Leora Horwitz, MD, MHS, New York University School of Medicine
    • Chohreh Partovian, MD, PhD, Yale School of Medicine
    • Zhenqiu Lin, PhD, Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation (YNHHSC/CORE)
    • Jeph Herrin, PhD, Yale School of Medicine
    • Jacqueline Grady, MS, YNHHSC/CORE
    • Mitchell Conover, BA, YNHHSC/CORE
    • Julia Montague, MPH, Yale School of Medicine
    • Chloe Dillaway, BA, YNHHSC/CORE
    • Kathleen Bartczak, BA, YNHHSC/CORE
    • Lisa Suter, MD, MHS, Yale School of Medicine
    • Joseph Ross, MD, MHS, Mount Sinai School of Medicine
    • Susannah Bernheim, MD, MHS, YNHHSC/CORE
    • Harlan Krumholz, MD, SM, Yale School of Medicine
    • Elizabeth Drye, MD, SM, Yale School of Medicine
    • Steven Jencks, MD, MPH, Consultant in Healthcare Safety and Quality
    • Sharon-Lise Normand, PhD, Harvard Medical School, Department of Health Care Policy
    • Leslie Conwell, PhD, Mathematica Policy Research, Inc.
    • Thomas Crogan, MD, PhD, Mathematica Policy Research, Inc.
    • Robert Saunders, PhD, National Committee for Quality Assurance
    • Manasi Tirodkar, PhD, National Committee for Quality Assurance
    • Charles Cha, MD, FACS, Yale School of Medicine
    • Frank Detterbeck, MD, FACS, FCCP, Yale School of Medicine
    • Kevin Schuster, MD, FACS, Yale School of Medicine
    • Lein Han, PhD, Centers for Medicare & Medicaid Services (CMS)
    • Michael Rapp, MD, CMS
    • Jennifer Mattera, MPH, YNHHSC/CORE
    • Lori Geary, MPH, YNHHSC/CORE
    • Joel Andress, PhD, CMS
    • Karen Nakano, CMS
    • Shari Ling, MD, CMS

    Financial Disclosures/Other Potential Conflicts of Interest

    None

    Endorser

    National Quality Forum

    NQF Number

    1789

    Date of Endorsement

    2016 Dec 9

    Measure Initiative(s)

    Hospital Compare

    Hospital Inpatient Quality Reporting Program

    Adaptation

    This measure was not adapted from another source.

    Date of Most Current Version in NQMC

    2017 Mar

    Measure Maintenance

    Annual

    Date of Next Anticipated Revision

    2018 Apr

    Measure Status

    This is the current release of the measure.

    This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

    Source(s)

    Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). 2017 all-cause hospital-wide measure updates and specifications report. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017 Mar. 69 p.

    Measure Availability

    Source available from the QualityNet Web site External Web Site Policy.

    Check the QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

    Companion Documents

    The following are available:

    • Hospital compare: a quality tool provided by Medicare. [internet]. Washington (DC): U.S. Department of Health and Human Services; [accessed 2017 Oct 30]. Available from the Medicare Web site External Web Site Policy.
    • Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). 2017 Medicare hospital quality chartbook. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017. Available from the Centers for Medicare & Medicaid Services (CMS) Web site External Web Site Policy.

    NQMC Status

    This NQMC summary was completed by ECRI Institute on December 4, 2013. The information was verified by the measure developer on January 10, 2014.

    This NQMC summary was updated by ECRI Institute on December 5, 2014. The information was verified by the measure developer on January 21, 2015.

    This NQMC summary was updated by ECRI Institute on July 21, 2015. The information was verified by the measure developer on September 23, 2015.

    This NQMC summary was updated again by ECRI Institute on November 13, 2017. The information was verified by the measure developer on December 12, 2017.

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    Related HHS Measure

    From the HHS Measure Inventory

    Hospital-wide all-cause, unplanned readmission measure (HWR): the measure estimates a hospital-level risk-standardized readmission rate (RSRR) of unplanned, all-cause readmission after admission for any eligible condition within 30 days of hospital discharge. The measure reports a single summary risk-standardized readmission rate (RSRR), derived from the volume-weighted results of five different models, one for each of the following specialty cohorts based on groups of discharge condition categories or procedure categories: surgery/gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology, each of which will be described in greater detail below. The measure also indicates the hospital-level standardized risk ratios (SRR) for each of these five specialty cohorts. The outcome is defined as unplanned readmission for any cause within 30 days of the discharge date for the index admission. Admissions for planned procedures that are not accompanied by an acute diagnosis do not count as readmissions in the measure outcome. The target population is patients 18 and over. CMS annually reports the measure for patients who are 65 years or older and are enrolled in fee-for-service (FFS) Medicare and hospitalized in non-federal hospitals.

    Hospital-Wide All-Cause Unplanned Readmission Measure (HWR): This measure estimates the hospital-level, risk-standardized rate of unplanned, all-cause readmission after admission for any eligible condition within 30 days of hospital discharge (RSRR) for patients aged 18 and older. The measure reports a single summary RSRR, derived from the volume-weighted results of five different models, one for each of the following specialty cohorts (groups of discharge condition categories or procedure categories): surgery, gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology. The measure also indicates the hospital standardized risk ratios (SRR) for each of these five specialty cohorts. We developed the measure for patients 65 years and older using Medicare fee-for-service (FFS) claims and subsequently tested and specified the measure for patients aged 18 years and older using all-payer data. We used the California Patient Discharge Data (CPDD), a large database of patient hospital admissions, for our all-payer data.


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