Potentially Preventable 30-Day Post-Discharge Readmission Measure (Claims Based)
Identifying Attributes
Care Settings
Country
Publishing Organisation
Type of Quality Indicator
IOM Quality Dimension
Domain
Defining Attributes
Definition
Percentage of home health stays in which patients who had an acute inpatient discharge within the 30 days before the start of their home health stay and were admitted to an acute care hospital or long-term care hospital for unplanned, potentially preventable readmissions in the 30-day window beginning two days after home health discharge.
Numerator
Number of home health stays for patients who have a Medicare claim for unplanned, potentially preventable readmissions in the 30-day window beginning two days after home health discharge.
Denominator
Number of home health stays that begin during the 3-year observation period for patients who had an acute inpatient hospital discharge within the 30 days prior to the start of the home health stay and were discharged to the community from HH.
Exclusions
Excludes claims for patients who are under the age of 18 years Died during the home health stay, did not have a short-term acute-care stay within 30 days prior to a home health admission date, are transferred at the end of a stay to another home health agency or short-term acute care hospital, are not continuously enrolled in Parts A and B FFS Medicare for the 12 months prior to the post-acute admission date, and at least 31 days after the post- acute discharge date, or are ever enrolled in Part C Medicare Advantage during this period, are not discharged to the community, are discharged against medical advice (AMA), whose prior short-term acute-care stay was for nonsurgical treatment of cancer, are transferred to a federal hospital from the home health agency and who received care from a provider located outside USA.
Use of Risk Adjustment
Risk Adjustments
This measure calculates a risk-adjusted PPR rate for each home health agency. This is derived by first calculating a standardised risk ratio -- the predicted number of unplanned, potentially preventable hospital readmissions at the home health agency divided by the expected number of readmissions for the same patients if treated at the average home health agency. The standardised risk ratio is then multiplied by the mean readmission rate in the population (i.e., all Medicare FFS patients included in the measure) to generate the home health agency-level standardised readmission rate of potentially preventable readmissions. A hierarchical regression method using a logistic regression to predict the probability of a countable (potentially preventable, unplanned) readmission is used. Risk-adjustment variables include demographic and eligibility characteristics; principal diagnoses; types of surgery or procedure from the prior short-term stay; comorbidities; length of stay and ICU/CCU utilisation from the immediately prior short-term stay; and number of admissions in the year preceding home health start or resumption of care.
Stratifications
None
Data Attributes
Type of Data Collection
Data Collection Methods
Data from Medicare's eligibility database as well as fee-for-service (FFS) claims from the home health, inpatient, outpatient, and physician office settings. Calculated using two years of data.
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Home Health Quality Reporting (CMS and providers) CMS Care Compare - Home health services and CMS Provider Compare (CMS, providers and publicly reported).