Hospital-level, 30-day risk-standardised readmission rate for patients discharged from the hospital with diagnosis coding that meets one of the two following requirements: 1. Principal discharge diagnosis of pneumonia; or, 2. a. Principal discharge diagnosis of sepsis (that is not severe); and b. A secondary diagnosis of pneumonia coded as present on admission; and c. No secondary diagnosis of sepsis that is both severe and coded as present on admission.

30-day, all-cause readmissions for patients discharged from the hospital with diagnosis coding that meets one of the two following requirements: 1. Principal discharge diagnosis of pneumonia; or, 2. a. Principal discharge diagnosis of sepsis (that is not severe); and b. A secondary diagnosis of pneumonia coded as present on admission; and c. No secondary diagnosis of sepsis that is both severe and coded as present on admission. This measure looks for a dichotomous yes or no outcome of whether each admitted patient has an unplanned readmission within 30 days.

Admissions for patients that meet all of the following inclusion criteria: 1. Discharged from the hospital with diagnosis coding that meets one of the two following requirements: a. Principal discharge diagnosis of pneumonia; or b. (i). Principal discharge diagnosis of sepsis (that is not severe); and (ii). A secondary diagnosis of pneumonia coded as present on admission; and (iii). No secondary diagnosis of sepsis that is both severe and coded as present on admission. 2. Enrolled in Medicare fee-for-service Part A and Part B for the 12 months prior to the date of admission and Part A during the index admission

Pneumonia admissions within 30 days of discharge from a prior pneumonia index admission; discharged against medical advice.

Hierarchical logistic regression is used to adjust for differences in hospital case mix (age and clinical status of the patient, accounted for by adjusting for comorbidities) and to account for the clustering of patients within a hospital. The measure calculates a risk-standardised ratio of the number of predicted readmissions to the number of expected readmissions. This ratio is multiplied by the national observed readmission rate to get the risk-standardised readmission rate

Medicare fee-for-service claims data

CMS Care Compare - Hospitals (Publicly reported) Suspended from Hospital Readmission Reduction Program (CMS and Providers)

Crespin DJ, Whaley C. The effect of hospital discharge price increases on publicly reported measures of quality. Health Serv Res. 2023 Feb;58(1):91-100. doi: 10.1111/1475-6773.14040. Epub 2022 Aug 9. PMID: 35872595; PMCID: PMC9836939. Goldberg EM, Morphis B, Youssef R, Gardner R. An analysis of diagnoses that drive readmission: What can we learn from the hospitals in Southern New England with the highest and lowest readmission performance? R I Med J (2013). 2017 Aug 1;100(8):23-28. PMID: 28759896; PMCID: PMC5666576. www.cms.gov/medicare/quality/value-based-programs/hospital-readmissions www.cms.gov/medicare/quality/value-based-programs/hospital-readmissions data.cms.gov/provider-data/topics/hospitals/measures-and-current-data-collection-periods data.cms.gov/provider-data/topics/hospitals/overall-hospital-quality-star-rating

cmit.cms.gov/cmit/#/MeasureView?variantId=65&sectionNumber=1 www.cms.gov/medicare/quality/initiatives/hospital-quality-initiative/measure-methodology