To isolate hospital effects on risk-standardized hospital-readmission rates, Dr Harlan Krumholz examined readmission outcomes among patients who had multiple admissions for a similar diagnosis at more than one hospital within a given year.
The researchers divided the Centers for Medicare and Medicaid Services hospital-wide readmission measure cohort from 2014 through 2015 into 2 random samples.
All the patients in the cohort were Medicare recipients who were at least 65 years of age.
The team used the first sample to calculate the risk-standardized readmission rate within 30 days for each hospital, and classified hospitals into performance quartiles, with a lower readmission rate indicating better performance.
|The median risk-standardized readmission rate was 16%|
|New England Journal of Medicine|
The study sample included patients who had two admissions for similar diagnoses at different hospitals that occurred more than 1 month and less than 1 year apart, and the team compared the observed readmission rates among patients who had been admitted to hospitals in different performance quartiles.
In the performance-classification sample, the median risk-standardized readmission rate was 16%.
The research team sample included 37,508 patients who had 2 admissions for similar diagnoses at a total of 4272 different hospitals.
The observed readmission rate was consistently higher among patients admitted to hospitals in a worse-performing quartile than among those admitted to hospitals in a better-performing quartile.
However, the team noted that the only significant difference was observed when the patients were admitted to hospitals in which one was in the best-performing quartile and the other was in the worst-performing quartile.
Dr Krumholz's team comments, "When the same patients were admitted with similar diagnoses to hospitals in the best-performing quartile as compared with the worst-performing quartile of hospital readmission performance, there was a significant difference in rates of readmission within 30 days."
"The findings suggest that hospital quality contributes in part to readmission rates independent of factors involving patients."