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Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence

Author

Listed:
  • Claudia Fischer
  • Hester F Lingsma
  • Perla J Marang-van de Mheen
  • Dionne S Kringos
  • Niek S Klazinga
  • Ewout W Steyerberg

Abstract

Introduction: Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care. Methods: We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of-Science, Cochrane central and PubMed for the period of January 2001 to May 2013. Results: The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity. Conclusions: Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care.

Suggested Citation

  • Claudia Fischer & Hester F Lingsma & Perla J Marang-van de Mheen & Dionne S Kringos & Niek S Klazinga & Ewout W Steyerberg, 2014. "Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence," PLOS ONE, Public Library of Science, vol. 9(11), pages 1-9, November.
    • Handle: RePEc:plo:pone00:0112282
    DOI: 10.1371/journal.pone.0112282
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    References listed on IDEAS

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    1. Kunz, Johannes S. & Staub, Kevin E. & Winkelmann, Rainer, 2017. "Estimating Fixed Effects: Perfect Prediction and Bias in Binary Response Panel Models, with an Application to the Hospital Readmissions Reduction Program," IZA Discussion Papers 11182, Institute of Labor Economics (IZA).
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    4. Katschnig, Heinz & Straßmayr, Christa & Endel, Florian & Berger, Michael & Zauner, Günther & Kalseth, Jorid & Sfetcu, Raluca & Wahlbeck, Kristian & Tedeschi, Federico & Šprah, Lilijana, 2019. "Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitations," Health Policy, Elsevier, vol. 123(11), pages 1028-1035.
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    6. Meng, Zhaolin & Hui, Wen & Cai, Yuanyi & Liu, Jiazhou & Wu, Huazhang, 2020. "The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: A systematic review and meta-analysis," Health Policy, Elsevier, vol. 124(4), pages 359-367.
    7. Ranveig Marie Boge & Arvid Steinar Haugen & Roy Miodini Nilsen & Frøydis Bruvik & Stig Harthug, 2019. "Discharge care quality in hospitalised elderly patients: Extended validation of the Discharge Care Experiences Survey," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-15, September.
    8. Braulio A Marfil-Garza & Pablo F Belaunzarán-Zamudio & Alfonso Gulias-Herrero & Antonio Camiro Zuñiga & Yanink Caro-Vega & David Kershenobich-Stalnikowitz & José Sifuentes-Osornio, 2018. "Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-14, November.
    9. Ramkumar Janakiraman & Eunho Park & Emre M. Demirezen & Subodha Kumar, 2023. "The Effects of Health Information Exchange Access on Healthcare Quality and Efficiency: An Empirical Investigation," Management Science, INFORMS, vol. 69(2), pages 791-811, February.
    10. Damien Échevin & Bernard Fortin & Aristide Houndetoungan, 2023. "Healthcare Quality by Specialists under a Mixed Compensation System: an Empirical Analysis," CIRANO Working Papers 2023s-19, CIRANO.
    11. Na-Eun Cho & KiHoon Hong, 2021. "Toward a More Complete Picture of Readmission-Decreasing Initiatives," Sustainability, MDPI, vol. 13(16), pages 1-8, August.
    12. Jacek Kryś & Błażej Łyszczarz & Zofia Wyszkowska & Kornelia Kędziora-Kornatowska, 2019. "Prevalence, Reasons, and Predisposing Factors Associated with 30-day Hospital Readmissions in Poland," IJERPH, MDPI, vol. 16(13), pages 1-14, July.
    13. Roos, Anne-Fleur & O’Donnell, Owen & Schut, Frederik T. & Van Doorslaer, Eddy & Van Gestel, Raf & Varkevisser, Marco, 2020. "Does price deregulation in a competitive hospital market damage quality?," Journal of Health Economics, Elsevier, vol. 72(C).
    14. Menghan Shen & Xiaoxia Liang & Linyan Li & Yushan Wu & Yuanfan Yang & Raphael Zingg, 2022. "The Association of Attending Physicians’ Publications and Patients’ Readmission Rates: Evidence from Tertiary Hospitals in China Using a Retrospective Data Analysis," IJERPH, MDPI, vol. 19(15), pages 1-12, August.
    15. Tortorella, Guilherme Luz & Fogliatto, Flavio S. & Kurnia, Sherah & Thürer, Matthias & Capurro, Daniel, 2022. "Healthcare 4.0 digital applications: An empirical study on measures, bundles and patient-centered performance," Technological Forecasting and Social Change, Elsevier, vol. 181(C).
    16. Nila Larisse Silva de Albuquerque & Thelma Leite de Araujo & Marcos Venicios de Oliveira Lopes & Thereza Maria Magalhães Moreira, 2020. "Hierarchical analysis of factors associated with hospital readmissions for coronary heart disease: A case–control study," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(13-14), pages 2329-2337, July.
    17. Hilland, Geir Haakon & Hagen, Terje P. & Martinussen, Pål E., 2023. "Stayin’ alive: The introduction of municipal in-patient acute care units was associated with reduced mortality and fewer hospital readmissions," Social Science & Medicine, Elsevier, vol. 326(C).
    18. Ghazalbash, Somayeh & Zargoush, Manaf & Mowbray, Fabrice & Costa, Andrew, 2022. "Impact of multimorbidity and frailty on adverse outcomes among older delayed discharge patients: Implications for healthcare policy," Health Policy, Elsevier, vol. 126(3), pages 197-206.

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