Are hospital readmission rates reliable care quality measures?

Rates are a measure of utilization not an outcome, says Harvard School of Public Health professor
Tools

New federal research that shows that contrary to earlier concerns, hospitals don't hike observation status to create the illusion of a drop in readmissions, has called into question whether readmissions are a reliable care quality measure.

Ashish Jha, M.D., an associate professor of Health Policy and Management at the Harvard School of Public Health, in a post for The Health Care Blog, called the latest findings good news. But he said that readmission rates are a measure of utilization, not an outcome in and of itself.

In some cases, he wrote, improved readmission rates might not indicate improved care, but rather, better care coordination, follow-up and communications. Alternately, in some cases, patients may simply have more barriers to the process of readmission.

Moreover, he said further study is needed to determine whether readmissions penalties have created incentives to improve readmissions rates at the expense of other measures, such as infection rates or mortality.

Meanwhile, a new study published in the Journal of the American College of Cardiology found that public reporting hasn't moved the needle on readmission rates for several key conditions.

Researchers, led by Adam DeVore, M.D., of the Duke Clinical Research Institute in Durham, North Carolina, analyzed six years of Medicare claims data and found "no association between the 2009 CMS policy decision to report hospital readmission rates and changes in trends for readmission rates publicly," they wrote.

To learn more:
- read the blog post
- here's the study abstract

Related Articles:
Fed data contradicts theory that observation stays skew readmissions data
Evidence grows of link between increased observation stays, lower readmissions
As readmissions fall, observation status rises--even at hospitals outside readmissions program
Observation status, ED visits create illusion of fewer readmissions, quality gains
New Virginia law requires hospitals to inform patients of observation status
Senate hears providers' concerns about observation status crisis
Senate committee hears stories on observation status, two-midnight rule
No one-size-fits-all strategy for readmission reduction
Non-clinical care coordination process improves discharge process, reduces readmission
'Patient navigators' reduced readmissions, overuse of ER in pilot program
Best practices to reduce costly readmissions