Can use of an administrative database improve accuracy of hospital-reported readmission rates?

The Journal of Thoracic and Cardiovascular Surgery

Baron L. Hamman¹  James R. Edgerton²  Morley A. Herbert³ 

[1] Department of Clinical Research, Medical City, Dallas, Tex;Texas Quality Initiative, Irving, Tex;The Heart Hospital Baylor Plano, Plano, Tex

关键词: readmission after cardiac surgery;    clinical database;    administrative database;    readmission;    database;    hospital reported;    accuracy of readmission;   

DOI  :  10.1016/j.jtcvs.2017.11.071

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectivesReadmission rates after cardiac surgery are being used as a quality indicator; they are also being collected by Medicare and are tied to reimbursement. Accurate knowledge of readmission rates may be difficult to achieve because patients may be readmitted to different hospitals. In our area, 81 hospitals share administrative claims data; 28 of these hospitals (from 5 different hospital systems) do cardiac surgery and share Society of Thoracic Surgeons (STS) clinical data. We used these 2 sources to compare the readmissions data for accuracy.MethodsA total of 45,539 STS records from January 2008 to December 2016 were matched with the hospital billing data records. Using the index visit as the start date, the billing records were queried for any subsequent in-patient visits for that patient. The billing records included date of readmission and hospital of readmission data and were compared with the data captured in the STS record.ResultsWe found 1153 (2.5%) patients who had STS records that were marked "No" or "missing," but there were billing records that showed a readmission. The reported STS readmission rate of 4796 (10.5%) underreported the readmission rate by 2.5 actual percentage points. The true rate should have been 13.0%. Actual readmission rate was 23.8% higher than reported by the clinical database. Approximately 36% of readmissions were to a hospital that was a part of a different hospital system.ConclusionsIt is important to know accurate readmission rates for quality improvement processes and institutional financial planning. Matching patient records to an administrative database showed that the clinical database may fail to capture many readmissions. Combining data with an administrative database can enhance accuracy of reporting.

【 授权许可】

Unknown