Despite their use for determining which readmissions are preventable, models that predict hospital readmissions perform poorly, according to a new study published in the Journal of the American Medical Association (JAMA).
Hospitals oftentimes use predictive models to determine which patients are at risk for readmissions and then intervene to avoid rehospitalization. In addition, predictive models often play into risk adjustment that determines the way hospitals are compared to each other and, therefore, reimbursed. Researchers, however, warned that not all models perform the way they should. Although predictive readmission models are useful in some settings, they argued that healthcare institutions need better models to assess hospital performance in discharging patients and to identify at-risk patients.
They looked at 26 validated hospital readmission risk prediction models across various settings and patient populations, according to a press release yesterday.
Although most models accounted for variables such as medical comorbidity and use of prior medical services, few models accounted for variables associated with overall health and function, illness severity, or social determinants of health.
"... [T]he poor discriminative ability of most of the administrative models we examined raises concerns about the ability to standardize risk across hospitals to fairly compare hospital performance," the researchers wrote. "Until risk prediction and risk adjustment become more accurate, it seems inappropriate to compare hospitals in this way and reimburse (or penalize) them on the basis of risk-standardized readmission rates."
The researchers added that more literature is needed to examine the models if they included other patient data, such as psychosocial factors. "These models should ideally be based on population-specific conceptual frameworks of risk," they wrote.
The study builds on other skepticism that surrounds readmission rates as a basis for quality performance. For example, an American Hospital Association report last month indicated that readmission rates were an "ill-suited" quality indicator in that not all readmissions can (or should) be avoided.
Starting in 2013, hospitals will be penalized for high readmissions rates under the Hospital Readmissions Reduction Program.
For more information:
- read the press release
- here's the study abstract
Related Articles:
High-readmission hospitals use follow-up to keep patients from returning
Hospital readmission rates stagnant
AHA report: Not all readmission readmissions avoidable, 'ill-suited' quality indicator