Standardised Readmission Ratio for Dialysis Facilities
Identifying Attributes
Care Settings
Country
Publishing Organisation
Type of Quality Indicator
IOM Quality Dimension
Domain
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
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
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
Frequency of Data Collection in Days
Reporting Methods
Dialysis Facility Care Compare and ESRD QIP datasets.