Hospital 30-day, all-cause, risk-standardized readmission rate (RSRR) following an acute ischemic stroke hospitalization

NQF ENDORSEMENT STATUS: Not Endorsed  |  NQF ID: 9999  |  MEASURE TYPE: Outcome  |  INFO AS OF: Not available  |  CMIT ID: 5043  |  REVISION: 1
The measure estimates a hospital-level risk-standardized readmission rate (RSRR) for patients discharged from the hospital with a principal diagnosis of acute ischemic stroke. We define this as readmission for any cause within 30 days from the date of discharge of the index stroke admission.
Info As Of Not available
Description The measure estimates a hospital-level risk-standardized readmission rate (RSRR) for patients discharged from the hospital with a principal diagnosis of acute ischemic stroke. We define this as readmission for any cause within 30 days from the date of discharge of the index stroke admission.
Numerator Note: This outcome measure does not have a traditional numerator and denominator like a core process measure (e.g., percentage of adult patients with diabetes aged 18-75 years receiving one or more hemoglobin A1c tests per year); thus, we are using this field to define the outcome and to which hospital the outcome is attributed when there are multiple hospitalizations within a single episode of care.) The outcome for this measure is 30-day all-cause readmission. We define all-cause readmission as readmission for any cause within 30 days from the date of discharge of the index stroke for patients discharged from the hospital with a principal diagnosis of ischemic stroke. If a patient has one or more admissions (for any reason) within 30 days after discharge from the index admission, only one is counted as a readmission. Measure includes unplanned readmissions to any acute care hospital for any cause within 30 days from the date of discharge of the index admission. Planned Readmissions: With this measure, CMS seeks to count only unplanned readmissions, as planned readmissions generally are not a signal of quality of care. We have adapted an algorithm originally created to identify planned readmissions for a hospital-wide (i.e., not condition-specific) readmission measure to this stroke readmission measure. In brief, the algorithm identifies a short list of always planned readmissions (those where the principle discharge diagnosis is major organ transplant, obstetrical delivery, or maintenance chemotherapy) as well as those readmissions with a potentially planned procedure (e.g., total hip replacement or cholecystectomy) AND a non-acute principle discharge diagnosis code. For example, a readmission for colon resection is considered planned if the principal diagnosis is colon cancer but unplanned if the principal diagnosis is abdominal pain, as the latter might represent a complication of the stroke hospitalization. Readmissions that included potentially planned procedures with acute diagnoses or that might represent complications of stroke are not considered planned. Overall, only 0.6% of all index admissions were associated with a planned readmission (and not counted in the measure outcome). More details about the planned readmission algorithm can be found on the CMS website at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Measure-Methodology.html.
Denominator Note: This outcome measure does not have a traditional numerator and denominator like a core process measure (e.g., percentage of adult patients with diabetes aged 18-75 years receiving one or more hemoglobin A1c tests per year). We therefore use this field to define the measure cohort. The denominator includes patients 65 years and older who were admitted to non-federal acute care hospitals for an ischemic stroke as defined by the following ICD-9-CM codes and with a complete claims history for the 12 months prior to admission: ICD-9-CM codes used to define ischemic stroke: 433.01 Occlusion and stenosis of precerebral arteries, Basilar artery with cerebral infarction 433.11 Occlusion and stenosis of precerebral arteries, Carotid artery with cerebral infarction 433.21 Occlusion and stenosis of precerebral arteries, Vertebral artery with cerebral infarction 433.31 Occlusion and stenosis of precerebral arteries, Multiple and bilateral with cerebral infarction 433.81 Occlusion and stenosis of precerebral arteries, Other specified precerebral artery with cerebral infarction 433.91 Occlusion and stenosis of precerebral arteries, Unspecified precerebral artery with cerebral infarction, Precerebral artery NOS 434.01 Occlusion of cerebral arteries, Cerebral thrombosis with cerebral infarction, thrombosis of cerebral arteries 434.11 Occlusion of cerebral arteries, Cerebral embolism with cerebral infarction 434.91 Occlusion of cerebral arteries, Cerebral artery occlusion, unspecified, with cerebral infarction
Denominator Exclusions Exclusions: An index admission is the hospitalization considered for the readmission outcome (readmitted within 30 days of the date of discharge from the initial admission). The measure excludes admissions for patients: with an in-hospital death (because they are not eligible for readmission). transferred to another acute care facility (because the readmission is attributed to the hospital that discharges the patient to a non-acute setting). discharged alive and against medical advice (AMA) (because providers did not have the opportunity to deliver full care and prepare the patient for discharge). without at least 30 days post-discharge claims data (because the 30-day readmission outcome cannot be assessed in this group). In addition, if a patient has more than one admission within 30 days of discharge from the index admission, only one is counted as a readmission, as we are interested in a dichotomous yes/no readmission outcome, as opposed to the number of readmissions. No admissions within 30 days of discharge from an index admission are considered as additional index admissions, thus no hospitalization will be counted as both a readmission and an index admission. The next eligible index admission is 30 days after the discharge date of the previous index admission.
Rationale Stroke is a leading cause of morbidity for patients. It increases patients' likelihood of dependence on the healthcare system and is a condition that contributes greatly to the cost of healthcare in the U.S. There is good evidence of variation in readmission rates for stroke patients. For these reasons stroke is an important target for quality measurement and improvement initiatives. Stroke is a priority area for outcomes measure development as it is a relatively common condition with potentially debilitating effects. Approximately 7 million Americans have experienced and survived a stroke (AHA, 2012). Stroke affects approximately 795,000 people each year in the US, and of these strokes, about 610,000 are first attacks and 185,000 are recurrent attacks (AHA, 2012). By 2030, it is projected than an additional 4 million people will have had a stroke, a 24.9% increase in prevalence from 2010 (AHA, settings. Both of these factors provide numerous opportunities for potential readmissions, and, consequently, opportunities to reduce readmission rates with appropriate interventions and care decisions. The goal of this measure is to improve patient outcomes by providing patients, physicians, and hospitals with information about hospital-level, risk-standardized readmission rates following hospitalization for stroke. Measurement of patient outcomes allows for a broad view of quality of care that encompasses more than what can be captured by individual process-of-care measures. Complex and critical aspects of care, such as communication between providers, prevention of, and response to, complications, patient safety and coordinated transitions to the outpatient environment, all contribute to patient outcomes but are difficult to measure by individual process measures. The goal of outcomes measurement is to risk-adjust for patients' conditions at the time of hospital admission and then evaluate patient outcomes. This readmission measure was developed to identify institutions, whose performance is better or worse than would be expected based on their patient case-mix, and therefore promote hospital quality improvement and better inform consumers about care quality. --- American Heart Association, Heart Disease and Stroke Statistics - 2012 Update. American Heart Association, Circulation 2012, 125:e2-e220. 2012). Stroke is a disease associated with high rates of preventable complications and discharge to settings with substantial requirements for ongoing care, e.g. home health or rehabilitation settings. Both of these factors provide numerous opportunities for potential readmissions, and, consequently, opportunities to reduce readmission rates with appropriate interventions and care decisions. The goal of this measure is to improve patient outcomes by providing patients, physicians, and hospitals with information about hospital-level, risk-standardized readmission rates following hospitalization for stroke. Measurement of patient outcomes allows for a broad view of quality of care that encompasses more than what can be captured by individual process-of-care measures. Complex and critical aspects of care, such as communication between providers, prevention of, and response to, complications, patient safety and coordinated transitions to the outpatient environment, all contribute to patient outcomes but are difficult to measure by individual process measures. The goal of outcomes measurement is to risk-adjust for patients' conditions at the time of hospital admission and then evaluate patient outcomes. This readmission measure was developed to identify institutions, whose performance is better or worse than would be expected based on their patient case-mix, and therefore promote hospital quality improvement and better inform consumers about care quality. --- American Heart Association, Heart Disease and Stroke Statistics - 2012 Update. American Heart Association, Circulation 2012, 125:e2-e220.
Evidence Not available
Steward Centers for Medicare & Medicaid Services (CMS)
Contact Not available
Measure Developer Not available
Development Stage Not available
Measure Type Outcome
Meaningful Measure Area Not available
Healthcare Priority Promoting Effective Communication and Coordination of Care
eCQM Spec Available Not Available
NQF Endorsement Status Not Endorsed
NQF ID 9999  (NQF Website )
Last NQF Update Not available
Target Population Age 65+
Target Population Age (High) Not available
Target Population Age (Low) 65
Reporting Level Not available
Conditions Cardiovascular Disease
Subconditions Ischemic Stroke
Care Settings

  Core Measure Set  :   Not available


Measure Group Group Identifier Actions
There are no relationships associated with the measure at this time.
Info As Of Not Available
Program / Model Notes
Data Sources Not Specified
Purposes Not available
Quality Domain Not available
Reporting Frequency Not available
Impacts Payment Not available
Reporting Status Unknown
Data Reporting Begin Date Not Available
Data Reporting End Date Not Available
Milestone Effective Date Comments Links Other Data Actions
Considered 2013-12-01 Not available
MUC Year 2013
MUC ID F2027
Reference 1900-01-01 Not available
There are no links associated with the measure at this time.