An Administrative Claims Measure Suitable for Profiling Hospital Performance on the Basis of 30-Day All-Cause Readmission Rates Among Patients With Heart Failure

TLDR

Readmission soon after discharge is an expensive and often preventable event for patients with heart failure. The authors present a National Quality Forum–approved model for public reporting of hospital‑level 30‑day all‑cause readmission rates for heart‑failure patients by CMS. They developed and validated a hierarchical logistic regression model using 2004 Medicare claims data and medical record data to calculate risk‑standardized 30‑day readmission rates for heart‑failure admissions. The model, comprising 37 variables, achieved a c‑statistic of 0.60, discriminated 15–37% across deciles, produced hospital risk‑standardized rates of 23.1–24.0% (25th–75th percentile), and showed that hospitals 1 SD above average had 1.30 times the odds of readmission, with state‑level rates correlating 0.97 with a medical‑record model, indicating the claims‑based estimates can serve as surrogates.

Abstract

Background— Readmission soon after hospital discharge is an expensive and often preventable event for patients with heart failure. We present a model approved by the National Quality Forum for the purpose of public reporting of hospital-level readmission rates by the Centers for Medicare & Medicaid Services. Methods and Results— We developed a hierarchical logistic regression model to calculate hospital risk-standardized 30-day all-cause readmission rates for patients hospitalized with heart failure. The model was derived with the use of Medicare claims data for a 2004 cohort and validated with the use of claims and medical record data. The unadjusted readmission rate was 23.6%. The final model included 37 variables, had discrimination ranging from 15% observed 30-day readmission rate in the lowest predictive decile to 37% in the upper decile, and had a c statistic of 0.60. The 25th and 75th percentiles of the risk-standardized readmission rates across 4669 hospitals were 23.1% and 24.0%, with 5th and 95th percentiles of 22.2% and 25.1%, respectively. The odds of all-cause readmission for a hospital 1 standard deviation above average was 1.30 times that of a hospital 1 standard deviation below average. State-level adjusted readmission rates developed with the use of the claims model are similar to rates produced for the same cohort with the use of a medical record model (correlation, 0.97; median difference, 0.06 percentage points). Conclusions— This claims-based model of hospital risk-standardized readmission rates for heart failure patients produces estimates that may serve as surrogates for those derived from a medical record model.