Standardised Readmission Ratio for Dialysis Facilities

Identifying Attributes

Care Settings
Care Transitions
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): End-Stage Renal Disease Quality Incentive Program
Type of Quality Indicator
Outcome
IOM Quality Dimension
Effectiveness
Domain
Hospitalisation

Defining Attributes

Definition

The ratio of the number of index discharges from acute care hospitals that resulted in an unplanned readmission to an acute care hospital within 4-30 days of discharge for dialysis patients treated at a particular dialysis facility, to the number of readmissions that would be expected (given the discharging hospitals and the characteristics of the patients, as well as the national norm for dialysis facilities).

Numerator

The observed number of index hospital discharges that are followed by an unplanned hospital readmission within 4–30 days of discharge.

Denominator

The expected number of index discharges followed by an unplanned readmission within 4-30 days in each facility (accounting for patient characteristics, the dialysis facility to which the patient is discharged, and the discharging acute care or critical access hospitals involved).

Exclusions

Discharges from skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), rehabilitation hospitals and PPS-exempt cancer hospitals - as well as those from separate dedicated units for hospice, rehabilitation and psychiatric care - are excluded Index hospital discharges that: Occurred at a non-acute care hospital; End in death; Are against medical advice; Include a primary diagnosis for certain types of cancer, mental health or rehab prosthesis; for rehabilitation; Occur after a patient's 5th admission in the calendar year; Are from a PPS-exempt cancer hospital; Where the patient was not on dialysis and under care of a dialysis facility at discharge; It is followed within 3 days by any hospitalisation (at acute care, long-term care, rehabilitation, or psychiatric hospital or unit), death, transplant, loss to follow up, withdrawal from dialysis, or recovery of renal function; Are associated with an inpatient stay of 365 days or longer.

Use of Risk Adjustment
Yes
Risk Adjustments

Age, sex, diabetes status, duration of ESRD, BMI at start of dialysis, past-year comorbidities, length of the index discharge hospital stay, nursing home status in previous 365 days, Medicare Advantage status at time of index discharge, presence of a high-risk diagnosis at index discharge, diagnosis of COVID-19 determined from Medicare claims. Model adjusts for facility indicators as fixed effects, and effects of discharging hospitals as random effects, accounting for the variation in readmission outcome across different hospitals.

Stratifications

Data Attributes

Type of Data Collection
Administrative data
Data Collection Methods

National ESRD patient database based on data from the CMS and EQRS system, Medicare dialysis and hospital payment records, the OPTN, and the Social Security Death Master File ( (CMS-2744), the CMS Medical Evidence Form (CMS-2728), and the Death Notification Form (CMS-2746). The database is comprehensive for Medicare-covered ESRD patients. Information on hospitalisations is obtained from Medicare Inpatient Claims Standard Analysis Files (SAFs) and past-year comorbidity is obtained from inpatient Medicare Claims SAFs.

Frequency of Data Collection
Annually
Frequency of Data Collection in Days
365
Reporting Methods

Dialysis Facility Care Compare and ESRD QIP datasets.

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

Source and Reference Attributes

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