Hospital 30-Day, All-Cause, Risk-Standardised Readmission Rate Following Acute Myocardial Infarction Hospitalisation
Identifying Attributes
Care Settings
Country
Publishing Organisation
Type of Quality Indicator
IOM Quality Dimension
Domain
Defining Attributes
Definition
Hospital-level, 30-day risk-standardised readmission rate for patients discharged from the hospital with a principal discharge diagnosis of acute myocardial infarction.
Numerator
30-day, all-cause readmissions for patients discharged from the hospital with a principal discharge diagnosis of Acute Myocardial Infarction. This measure looks for a dichotomous yes or no outcome of whether each admitted patient has an unplanned readmission within 30 days.
Denominator
Admissions for patients: 1. Discharged from the hospital with a principal discharge diagnosis of AMI; 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; 3. Aged 65 or over; 4. Discharged alive; 5. Not transferred to another acute care facility.
Exclusions
Index admissions without at least 30 days of post-discharge enrolment in Medicare fee-for-service; same-day discharges; Acute Myocardial Infarction admissions within 30 days of discharge from a prior Acute Myocardial Infarction index admission; discharged against medical advice; with a principal diagnosis/secondary diagnosis code of COVID-19 coded as present on admission on the index admission claim.
Use of Risk Adjustment
Risk Adjustments
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 (RSRR).
Stratifications
Data Attributes
Type of Data Collection
Data Collection Methods
Medicare fee-for-service (FFS) claims data.
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Hospital Readmission Reduction Program (CMS and Providers) CMS Care Compare - Hospitals and Provider Data Catalogue (Publicly reported).
Reporting Frequency
Reporting Frequency in Days
Indicator Has Recommended Targets
Source and Reference Attributes
Evidence Source
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 data.cms.gov/provider-data/topics/hospitals/measures-and-current-data-collection-periods