Clinical, Socioeconomic Factors May Have More Influence Than Quality of Care on Hospital Readmission Rates: AHRQ Study

Hospital readmission rates appear to be more influenced by clinical and socioeconomic factors than the quality of care that patients receive, according to an AHRQ-funded study. Using data from four state inpatient databases that are part of AHRQ’s Healthcare Cost and Utilization Project, researchers examined the relationship between inpatient quality of care and all-cause, hospitalwide 30-day readmission rates. Quality of care was measured by AHRQ’s Patient Safety Indicator (PSI) Composite, which indicates potential in-hospital complications and adverse events. The study found that the risk-adjusted PSI composite was not significantly associated with 30-day readmission rates after controlling for structural and sociodemographic factors. The findings suggest that the composite measure of hospital patient safety could be enhanced with the capture of more complications, both inpatient and post-discharge. The authors called for more research to better understand the social factors related to transitional care and the reasons communities with lower socioeconomic status have higher readmission rates. The study, “Hospital-Level Factors Related to 30-Day Readmission Rates,” and abstract appeared in theAmerican Journal of Medical Quality.

2015 Oct 29. pii: 1062860615612158. [Epub ahead of print]

Hospital-Level Factors Related to 30-Day Readmission Rates.

Campione JR1, Smith SA2, Mardon RE2.

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Abstract

This study investigates the relationship between inpatient quality of care as measured by the Agency for Healthcare Research and Quality (AHRQ) patient safety indicator (PSI) composite and all-cause, hospital-wide, 30-day readmission rates. Discharge data from 4 statewide databases were analyzed. Linear, repeated-measures regressions were performed to predict hospital-level 30-day readmission rates. The mean readmission rate was 12.9%, and the mean PSI composite ratio was 0.95 among 524 hospitals with 2592 observations. In the hospital-level analysis, the risk-adjusted AHRQ PSI composite was not significantly associated with hospital 30-day readmission rate after controlling for hospital-level characteristics, patient case mix, and sociodemographics. Inpatient quality of care appears to have less influence on hospital readmission rates than do clinical and socioeconomic factors. However, these results suggest that a patient safety composite measure that includes postdischarge complications would provide more information to assist hospitals and communities in understanding the association between quality of care and readmission rates.