Hospital readmissions and quality of care

BACKGROUND. Readmission rates are often proposed as markers for quality of care. However, a consistent link between readmissions and quality has not b een established. OBJECTIVE. To test the relation of readmission to quality and the utility o f readmissions as hospital quality measures. SUBJECTS. One thousand, seven hundred and fifty-eight Medicare patients hos pitalized in four states between 1991 to 1992 with pneumonia or congestive heart failure (CHE). DESIGN. Case control. MEASURES. Related adverse readmissions (RARs), defined as readmissions that indicate potentially sub-optimal care during initial hospitalization, were identified from administrative data using readmission diagnoses and interv ening time periods designated by physician panels. We used linear regressio n to estimate the association between implicit and explicit quality measure s and readmission status (RARs, non-RAR readmissions, and nonread-missions) , adjusting for severity. We tested whether RARs were associated with infer ior care and performed simulations to determine whether RARs discriminated between hospitals on the basis of quality. RESULTS. Compared with nonreadmitted pneumonia patients, patients with RARs had lower adjusted quality measured both by explicit (0.25 standardized un its, P = 0.004) and implicit methods (0.17, P = 0.047). Adjusted difference s for CHF patients were 0.17 (P 0.048) and 0.20 (P = 0.017), respectively. In some analyses, patients with non-RAR readmissions also experienced lower quality. However, rates of inferior quality care did not differ significan tly by readmission status, and simulations identified no meaningful relatio nship between RARs and hospital quality of care. CONCLUSIONS. RARs are statistically associated with lower quality of care. However, neither RARs nor other readmissions appear to be useful tools for identifying patients who experience inferior care or for comparing quality among hospitals.