Don't use readmission rates as sole measure of hospital performance

Readmission rates may indicate quality but shouldn't be used alone to measure overall hospital performance, according to a new Health Affairs study.

Researchers compared quarterly rankings of hospitals based on readmission rates in 2009 and 2011 to determine whether they maintained their performance or shifts occurred that suggested changes in quality. They also looked at the relationship between readmission rates and several common hospital quality measures, such as standardized mortality rates, volume and teaching status.

The research team found readmission rates for lower performing hospitals in 2009 improved in 2011 while readmission rates for higher performing hospitals worsened during those same periods.

"We found … that whether a hospital's readmission rate went up or down, and to what degree if it did change, is explained in part (18–27 percent of the explanation, depending on the condition) by how high or low it was to start. This relationship was due primarily to regression to the mean, " the authors wrote.

As a result of their findings, researchers recommend the following approaches to improve the use of all-cause readmission rates as a quality measure:

  • Account for "regression-to-the mean" effect when assigning quality based on readmission rates
  • Augment readmission rates with other measures of hospital quality
  • Address care transitions involving other providers, such as outpatient physicians, home health agencies and nursing homes, in readmission policies

"We also recommend that policy makers build on current efforts that take a community-wide approach to measuring readmission rates and distributing incentives to reduce them," the authors wrote.

To learn more:
- here is the study abstract
- read the study (.pdf)