Implications of metric choice for common applications of readmission metrics

Health Serv Res. 2013 Dec;48(6 Pt 1):1978-95. doi: 10.1111/1475-6773.12075. Epub 2013 Jun 6.


Objective: To quantify the differential impact on hospital performance of three readmission metrics: all-cause readmission (ACR), 3M Potential Preventable Readmission (PPR), and Centers for Medicare and Medicaid 30-day readmission (CMS).

Data sources: 2000-2009 California Office of Statewide Health Planning and Development Patient Discharge Data Nonpublic file.

Study design: We calculated 30-day readmission rates using three metrics, for three disease groups: heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Using each metric, we calculated the absolute change and correlation between performance; the percent of hospitals remaining in extreme deciles and level of agreement; and differences in longitudinal performance.

Principal findings: Average hospital rates for HF patients and the CMS metric were generally higher than for other conditions and metrics. Correlations between the ACR and CMS metrics were highest (r = 0.67-0.84). Rates calculated using the PPR and either ACR or CMS metrics were moderately correlated (r = 0.50-0.67). Between 47 and 75 percent of hospitals in an extreme decile according to one metric remained when using a different metric. Correlations among metrics were modest when measuring hospital longitudinal change.

Conclusions: Different approaches to computing readmissions can produce different hospital rankings and impact pay-for-performance. Careful consideration should be placed on readmission metric choice for these applications.

Keywords: Administrative data uses; hospitals; quality of care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Benchmarking / methods*
  • California
  • Centers for Medicare and Medicaid Services, U.S. / statistics & numerical data*
  • Heart Failure / therapy*
  • Humans
  • Myocardial Infarction / therapy*
  • Patient Discharge / statistics & numerical data
  • Patient Readmission / statistics & numerical data*
  • Pneumonia / therapy*
  • Quality of Health Care / organization & administration
  • Risk Adjustment
  • United States