Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions
Identifieur interne : 000123 ( Main/Merge ); précédent : 000122; suivant : 000124Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions
Auteurs : Kumar Dharmarajan [États-Unis] ; Angela F. Hsieh [États-Unis] ; Zhenqiu Lin [États-Unis] ; Héctor Bueno [Espagne] ; Joseph S. Ross [États-Unis] ; Leora I. Horwitz [États-Unis] ; José Augusto Barreto-Filho [Brésil] ; Nancy Kim [États-Unis] ; Lisa G. Suter [États-Unis] ; Susannah M. Bernheim [États-Unis] ; Elizabeth E. Drye [États-Unis] ; Harlan M. Krumholz [États-Unis]Source :
- BMJ : British Medical Journal [ 0959-8138 ] ; 2013-11-20.
English descriptors
- Teeft :
- Access hospital teaching hospital safety, American federation, Annual medicaid caseload, Blood institute, Cohort, Common readmission diagnoses, Condition categories, Condition category, Contemporary practice, Critical access hospitals, Fewer readmissions, General strategies, Heart failure, High proportion, Hospital admission, Hospital characteristics, Hospital discharge, Hospital performance, Hospital performance categories, Hospital performance groups, Hospital readmissions, Hospital volume, Index admission, Index admissions, Index condition, Infarction, Intern, Interval estimate, Median, Median time, Medicaid, Medicaid health insurance, Medicaid patients, Medicaid services, Medicare, Medicare beneficiaries, Myocardial infarction, National heart, November, Other hospital characteristics, Pneumonia, Pneumonia cohorts, Private hospitals, Profit hospital, Qual, Readmission, Readmission diagnoses, Readmission patterns, Readmission rate, Readmission rates, Readmission timing, Regression models, Reprint, Rural hospital, Similar distribution, Specific diagnoses, Standard deviation increase, Study period, Time periods, Univariate analysis, Yale university.
Abstract
Objectives To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions. Design Retrospective cohort study. Setting Medicare beneficiaries in the United States. Participants Patients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09. Main outcome measures Readmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services’ condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers. Results For readmissions in the 30 days after the index admission, there were 320 003 after 1 291 211 admissions for heart failure (4041 hospitals), 102 536 after 517 827 admissions for acute myocardial infarction (2378 hospitals), and 208 438 after 1 135 932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P<0.001). Findings were unchanged after adjustment for other hospital characteristics potentially associated with readmission patterns. Conclusions High performing hospitals have proportionately fewer 30 day readmissions without differences in readmission diagnoses and timing, suggesting the possible benefit of strategies that lower risk of readmission globally rather than for specific diagnoses or time periods after hospital stay.
Url:
- https://api.istex.fr/document/4F6D0DD339378B54C38C59AF807F93A936A7FB51/fulltext/pdf
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898430
DOI: 10.1136/bmj.f6571
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<front><div type="abstract">Objectives To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions. Design Retrospective cohort study. Setting Medicare beneficiaries in the United States. Participants Patients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09. Main outcome measures Readmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services’ condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers. Results For readmissions in the 30 days after the index admission, there were 320 003 after 1 291 211 admissions for heart failure (4041 hospitals), 102 536 after 517 827 admissions for acute myocardial infarction (2378 hospitals), and 208 438 after 1 135 932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P<0.001). Findings were unchanged after adjustment for other hospital characteristics potentially associated with readmission patterns. Conclusions High performing hospitals have proportionately fewer 30 day readmissions without differences in readmission diagnoses and timing, suggesting the possible benefit of strategies that lower risk of readmission globally rather than for specific diagnoses or time periods after hospital stay.</div>
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<author><name sortKey="Horwitz, Leora I" sort="Horwitz, Leora I" uniqKey="Horwitz L" first="Leora I" last="Horwitz">Leora I. Horwitz</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Section of General Internal Medicine, Yale University School of Medicine, PO Box 208056, New Haven, CT 06520</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Barreto Filho, Jose Augusto" sort="Barreto Filho, Jose Augusto" uniqKey="Barreto Filho J" first="José Augusto" last="Barreto-Filho">José Augusto Barreto-Filho</name>
<affiliation wicri:level="2"><country xml:lang="fr">Brésil</country>
<wicri:regionArea>Division of Cardiology, Federal University of Sergipe, and Clínica e Hospital São Lucas, Rua Claudio Batista, S/N, Bairro Santo Antonio, 49060-100, Aracaju, Sergipe</wicri:regionArea>
<placeName><region type="state">Sergipe</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Kim, Nancy" sort="Kim, Nancy" uniqKey="Kim N" first="Nancy" last="Kim">Nancy Kim</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Section of General Internal Medicine, Yale University School of Medicine, PO Box 208056, New Haven, CT 06520</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Suter, Lisa G" sort="Suter, Lisa G" uniqKey="Suter L" first="Lisa G" last="Suter">Lisa G. Suter</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Section of Rheumatology, Yale University School of Medicine, PO Box 208031, New Haven, CT 06520</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Bernheim, Susannah M" sort="Bernheim, Susannah M" uniqKey="Bernheim S" first="Susannah M" last="Bernheim">Susannah M. Bernheim</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Drye, Elizabeth E" sort="Drye, Elizabeth E" uniqKey="Drye E" first="Elizabeth E" last="Drye">Elizabeth E. Drye</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Krumholz, Harlan M" sort="Krumholz, Harlan M" uniqKey="Krumholz H" first="Harlan M" last="Krumholz">Harlan M. Krumholz</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
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<monogr></monogr>
<series><title level="j">BMJ : British Medical Journal</title>
<title level="j" type="abbrev">BMJ</title>
<idno type="ISSN">0959-8138</idno>
<idno type="eISSN">1756-1833</idno>
<imprint><publisher>British Medical Journal Publishing Group</publisher>
<date type="published" when="2013-11-20">2013-11-20</date>
<biblScope unit="volume">347</biblScope>
</imprint>
<idno type="ISSN">0959-8138</idno>
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<seriesStmt><idno type="ISSN">0959-8138</idno>
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<profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Access hospital teaching hospital safety</term>
<term>American federation</term>
<term>Annual medicaid caseload</term>
<term>Blood institute</term>
<term>Cohort</term>
<term>Common readmission diagnoses</term>
<term>Condition categories</term>
<term>Condition category</term>
<term>Contemporary practice</term>
<term>Critical access hospitals</term>
<term>Fewer readmissions</term>
<term>General strategies</term>
<term>Heart failure</term>
<term>High proportion</term>
<term>Hospital admission</term>
<term>Hospital characteristics</term>
<term>Hospital discharge</term>
<term>Hospital performance</term>
<term>Hospital performance categories</term>
<term>Hospital performance groups</term>
<term>Hospital readmissions</term>
<term>Hospital volume</term>
<term>Index admission</term>
<term>Index admissions</term>
<term>Index condition</term>
<term>Infarction</term>
<term>Intern</term>
<term>Interval estimate</term>
<term>Median</term>
<term>Median time</term>
<term>Medicaid</term>
<term>Medicaid health insurance</term>
<term>Medicaid patients</term>
<term>Medicaid services</term>
<term>Medicare</term>
<term>Medicare beneficiaries</term>
<term>Myocardial infarction</term>
<term>National heart</term>
<term>November</term>
<term>Other hospital characteristics</term>
<term>Pneumonia</term>
<term>Pneumonia cohorts</term>
<term>Private hospitals</term>
<term>Profit hospital</term>
<term>Qual</term>
<term>Readmission</term>
<term>Readmission diagnoses</term>
<term>Readmission patterns</term>
<term>Readmission rate</term>
<term>Readmission rates</term>
<term>Readmission timing</term>
<term>Regression models</term>
<term>Reprint</term>
<term>Rural hospital</term>
<term>Similar distribution</term>
<term>Specific diagnoses</term>
<term>Standard deviation increase</term>
<term>Study period</term>
<term>Time periods</term>
<term>Univariate analysis</term>
<term>Yale university</term>
</keywords>
</textClass>
<langUsage><language ident="en">en</language>
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<front><div type="abstract">Objectives To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions. Design Retrospective cohort study. Setting Medicare beneficiaries in the United States. Participants Patients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09. Main outcome measures Readmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services’ condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers. Results For readmissions in the 30 days after the index admission, there were 320 003 after 1 291 211 admissions for heart failure (4041 hospitals), 102 536 after 517 827 admissions for acute myocardial infarction (2378 hospitals), and 208 438 after 1 135 932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P<0.001). Findings were unchanged after adjustment for other hospital characteristics potentially associated with readmission patterns. Conclusions High performing hospitals have proportionately fewer 30 day readmissions without differences in readmission diagnoses and timing, suggesting the possible benefit of strategies that lower risk of readmission globally rather than for specific diagnoses or time periods after hospital stay.</div>
</front>
</TEI>
</ISTEX>
<PMC><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions</title>
<author><name sortKey="Dharmarajan, Kumar" sort="Dharmarajan, Kumar" uniqKey="Dharmarajan K" first="Kumar" last="Dharmarajan">Kumar Dharmarajan</name>
<affiliation wicri:level="2"><nlm:aff id="aff1">Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, 630 West 168th Street, Box 93, PH 10-203, New York, NY 10032, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, 630 West 168th Street, Box 93, PH 10-203, New York, NY 10032</wicri:regionArea>
<placeName><region type="state">État de New York</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Hsieh, Angela F" sort="Hsieh, Angela F" uniqKey="Hsieh A" first="Angela F" last="Hsieh">Angela F. Hsieh</name>
<affiliation wicri:level="2"><nlm:aff id="aff2">Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Lin, Zhenqiu" sort="Lin, Zhenqiu" uniqKey="Lin Z" first="Zhenqiu" last="Lin">Zhenqiu Lin</name>
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<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Bueno, Hector" sort="Bueno, Hector" uniqKey="Bueno H" first="Héctor" last="Bueno">Héctor Bueno</name>
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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Department of Cardiology, Hospital General Universitario Gregorio Marañón, Dr Esquerdo 46 Madrid 28007</wicri:regionArea>
<placeName><region nuts="2" type="communauté">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Ross, Joseph S" sort="Ross, Joseph S" uniqKey="Ross J" first="Joseph S" last="Ross">Joseph S. Ross</name>
<affiliation wicri:level="2"><nlm:aff id="aff4">Section of General Internal Medicine, Yale University School of Medicine, PO Box 208056, New Haven, CT 06520, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Section of General Internal Medicine, Yale University School of Medicine, PO Box 208056, New Haven, CT 06520</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Horwitz, Leora I" sort="Horwitz, Leora I" uniqKey="Horwitz L" first="Leora I" last="Horwitz">Leora I. Horwitz</name>
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<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Section of General Internal Medicine, Yale University School of Medicine, PO Box 208056, New Haven, CT 06520</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Barreto Filho, Jose Augusto" sort="Barreto Filho, Jose Augusto" uniqKey="Barreto Filho J" first="José Augusto" last="Barreto-Filho">José Augusto Barreto-Filho</name>
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<country xml:lang="fr">Brésil</country>
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<placeName><region type="state">Sergipe</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Kim, Nancy" sort="Kim, Nancy" uniqKey="Kim N" first="Nancy" last="Kim">Nancy Kim</name>
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<country xml:lang="fr">États-Unis</country>
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<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Suter, Lisa G" sort="Suter, Lisa G" uniqKey="Suter L" first="Lisa G" last="Suter">Lisa G. Suter</name>
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<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Section of Rheumatology, Yale University School of Medicine, PO Box 208031, New Haven, CT 06520</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Bernheim, Susannah M" sort="Bernheim, Susannah M" uniqKey="Bernheim S" first="Susannah M" last="Bernheim">Susannah M. Bernheim</name>
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<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Drye, Elizabeth E" sort="Drye, Elizabeth E" uniqKey="Drye E" first="Elizabeth E" last="Drye">Elizabeth E. Drye</name>
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<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Krumholz, Harlan M" sort="Krumholz, Harlan M" uniqKey="Krumholz H" first="Harlan M" last="Krumholz">Harlan M. Krumholz</name>
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<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
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</placeName>
</affiliation>
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<author><name sortKey="Dharmarajan, Kumar" sort="Dharmarajan, Kumar" uniqKey="Dharmarajan K" first="Kumar" last="Dharmarajan">Kumar Dharmarajan</name>
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<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, 630 West 168th Street, Box 93, PH 10-203, New York, NY 10032</wicri:regionArea>
<placeName><region type="state">État de New York</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Hsieh, Angela F" sort="Hsieh, Angela F" uniqKey="Hsieh A" first="Angela F" last="Hsieh">Angela F. Hsieh</name>
<affiliation wicri:level="2"><nlm:aff id="aff2">Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Lin, Zhenqiu" sort="Lin, Zhenqiu" uniqKey="Lin Z" first="Zhenqiu" last="Lin">Zhenqiu Lin</name>
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<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Bueno, Hector" sort="Bueno, Hector" uniqKey="Bueno H" first="Héctor" last="Bueno">Héctor Bueno</name>
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<country xml:lang="fr">Espagne</country>
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<placeName><region nuts="2" type="communauté">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Ross, Joseph S" sort="Ross, Joseph S" uniqKey="Ross J" first="Joseph S" last="Ross">Joseph S. Ross</name>
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<country xml:lang="fr">États-Unis</country>
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<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Horwitz, Leora I" sort="Horwitz, Leora I" uniqKey="Horwitz L" first="Leora I" last="Horwitz">Leora I. Horwitz</name>
<affiliation wicri:level="2"><nlm:aff id="aff4">Section of General Internal Medicine, Yale University School of Medicine, PO Box 208056, New Haven, CT 06520, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Section of General Internal Medicine, Yale University School of Medicine, PO Box 208056, New Haven, CT 06520</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Barreto Filho, Jose Augusto" sort="Barreto Filho, Jose Augusto" uniqKey="Barreto Filho J" first="José Augusto" last="Barreto-Filho">José Augusto Barreto-Filho</name>
<affiliation wicri:level="2"><nlm:aff id="aff5">Division of Cardiology, Federal University of Sergipe, and Clínica e Hospital São Lucas, Rua Claudio Batista, S/N, Bairro Santo Antonio, 49060-100, Aracaju, Sergipe, Brazil</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>Division of Cardiology, Federal University of Sergipe, and Clínica e Hospital São Lucas, Rua Claudio Batista, S/N, Bairro Santo Antonio, 49060-100, Aracaju, Sergipe</wicri:regionArea>
<placeName><region type="state">Sergipe</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Kim, Nancy" sort="Kim, Nancy" uniqKey="Kim N" first="Nancy" last="Kim">Nancy Kim</name>
<affiliation wicri:level="2"><nlm:aff id="aff4">Section of General Internal Medicine, Yale University School of Medicine, PO Box 208056, New Haven, CT 06520, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Section of General Internal Medicine, Yale University School of Medicine, PO Box 208056, New Haven, CT 06520</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Suter, Lisa G" sort="Suter, Lisa G" uniqKey="Suter L" first="Lisa G" last="Suter">Lisa G. Suter</name>
<affiliation wicri:level="2"><nlm:aff id="aff6">Section of Rheumatology, Yale University School of Medicine, PO Box 208031, New Haven, CT 06520, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Section of Rheumatology, Yale University School of Medicine, PO Box 208031, New Haven, CT 06520</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Bernheim, Susannah M" sort="Bernheim, Susannah M" uniqKey="Bernheim S" first="Susannah M" last="Bernheim">Susannah M. Bernheim</name>
<affiliation wicri:level="2"><nlm:aff id="aff2">Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Drye, Elizabeth E" sort="Drye, Elizabeth E" uniqKey="Drye E" first="Elizabeth E" last="Drye">Elizabeth E. Drye</name>
<affiliation wicri:level="2"><nlm:aff id="aff2">Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Krumholz, Harlan M" sort="Krumholz, Harlan M" uniqKey="Krumholz H" first="Harlan M" last="Krumholz">Harlan M. Krumholz</name>
<affiliation wicri:level="2"><nlm:aff id="aff2">Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT 06510</wicri:regionArea>
<placeName><region type="state">Connecticut</region>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">The BMJ</title>
<idno type="ISSN">0959-8138</idno>
<idno type="eISSN">1756-1833</idno>
<imprint><date when="2013">2013</date>
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<front><div type="abstract" xml:lang="en"><p><bold>Objectives</bold>
To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions.</p>
<p><bold>Design </bold>
Retrospective cohort study.</p>
<p><bold>Setting</bold>
Medicare beneficiaries in the United States.</p>
<p><bold>Participants</bold>
Patients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09. </p>
<p><bold>Main outcome measures</bold>
Readmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services’ condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers.</p>
<p><bold>Results</bold>
For readmissions in the 30 days after the index admission, there were 320 003 after 1 291 211 admissions for heart failure (4041 hospitals), 102 536 after 517 827 admissions for acute myocardial infarction (2378 hospitals), and 208 438 after 1 135 932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P<0.001). Findings were unchanged after adjustment for other hospital characteristics potentially associated with readmission patterns.</p>
<p><bold>Conclusions</bold>
High performing hospitals have proportionately fewer 30 day readmissions without differences in readmission diagnoses and timing, suggesting the possible benefit of strategies that lower risk of readmission globally rather than for specific diagnoses or time periods after hospital stay.</p>
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