This measure scores a hospital on the incidence among its patients during the month following discharge from an inpatient stay having a primary diagnosis of heart failure for three types of events: readmissions, ED visits and evaluation and management (E&M) services.

The numerator is the weighted sum of the three deviations from their expected values for the individual measures comprising the component measure. The question of appropriate weights on the deviations is difficult and would probably lead to a wide variation in opinion. The weights of -4, -2, and 1 are selected to represent order of magnitude differences in seriousness of the three outcomes, which most would agree to (that is to say: readmission is more important than ED which is more important in a negative way than E & M service is in a positive way). The idea of not using weights was also considered, but this was noted to be itself a de facto weight scheme (with all weights the same), and as such, a weight scheme that was less appropriate than the one chosen.

The composite measure is the weighted sum of three individual measures. Thus, the denominator is one.

None

Each of these individual measures is a risk-adjusted, standardised rate together with a percentile ranking. This composite measure is a weighted average of the deviations of the three risk-adjusted, standardised rates from the population mean for the measure across all patients in all hospitals. Again, the composite measure is accompanied by a percentile ranking to help with its interpretation.

Administrative claims data

Measure Retired and Endorsement Removed 04.02.2014

www.qualityforum.org/QPS/0698