Hospital 30-Day, All-Cause, Risk-Standardised Readmission Rate Following Heart Failure Hospitalisation

Identifying Attributes

Care Settings
Care Transitions
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Hospital Readmission Reduction Program
Type of Quality Indicator
Outcome
IOM Quality Dimension
Effectiveness
Domain
Hospitalisation

Defining Attributes

Definition

Hospital-level, 30-day risk-standardised readmission rate for patients discharged from the hospital with a principal discharge diagnosis of heart failure.

Numerator

30-day, all-cause readmissions for patients discharged from the hospital with a principal discharge diagnosis of heart failure. 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 that meet all of the following inclusion criteria: 1. Discharged from the hospital with a principal discharge diagnosis of HF; 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.

Exclusions

Index admissions for patients that meet any of the following exclusion criteria: 1. Without at least 30 days of post-discharge enrolment in Medicare fee-for-service; 2. With a procedure code for left ventricular assist device implantation or heart transplantation either during the index admission or in the 12 months prior to the index admission; 3. HF admissions within 30 days of discharge from a prior HF index admission; 4. Discharged against medical advice; 5. With a principal diagnosis/secondary diagnosis code of COVID-19 coded as present on admission on the index admission claim.

Use of Risk Adjustment
Yes
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
Administrative data
Data Collection Methods

Medicare fee-for-service (FFS) claims data.

Frequency of Data Collection
Annually based on previous 24 months data
Frequency of Data Collection in Days
365
Reporting Methods

Hospital Readmission Reduction Program (CMS and Providers) CMS Care Compare - Hospitals and Provider Data Catalogue (Publicly reported).

Reporting Frequency
Annually
Reporting Frequency in Days
365
Indicator Has Recommended Targets
No

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 data.cms.gov/provider-data/topics/hospitals/overall-hospital-quality-star-rating

Link to Measurement Tools
Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
No
Australian Consortium for Aged Care Endorsed
No
Identified by PHARMA-Care Project
No
Upload Date
12 March 2025