Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data

NQF ENDORSEMENT STATUS: Endorsed  |  NQF ID: 2879e  |  MEASURE TYPE: Outcome  |  INFO AS OF: Not available  |  CMIT ID: 5286  |  REVISION: 2
This eMeasure estimates the hospital-level, risk-standardized rate of unplanned, all-cause readmission after admission for any eligible condition within 30 days of hospital discharge (RSRR). The eMeasure reports a single summary RSRR, derived from the volume-weighted results of five different models, one for each of the following specialty cohorts (grouped by discharge condition categories or procedure categories): surgery/gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology. The eMeasure also indicates the hospital standardized risk ratios (SRR) for each of these five specialty cohorts. This eMeasure is a re- engineering of measure 1789, the Hospital-Wide All-Cause Risk- Standardized Readmission Measure developed for patients 65 years and older using Medicare claims. This reengineered measure uses clinical data elements from patients' electronic health records for risk adjustment in addition to claims data.
Info As Of Not available
Description This eMeasure estimates the hospital-level, risk-standardized rate of unplanned, all-cause readmission after admission for any eligible condition within 30 days of hospital discharge (RSRR). The eMeasure reports a single summary RSRR, derived from the volume-weighted results of five different models, one for each of the following specialty cohorts (grouped by discharge condition categories or procedure categories): surgery/gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology. The eMeasure also indicates the hospital standardized risk ratios (SRR) for each of these five specialty cohorts. This eMeasure is a re- engineering of measure 1789, the Hospital-Wide All-Cause Risk- Standardized Readmission Measure developed for patients 65 years and older using Medicare claims. This reengineered measure uses clinical data elements from patients' electronic health records for risk adjustment in addition to claims data.
Numerator The outcome for this measure is unplanned all cause 30 day readmission. We defined a readmission as an inpatient admission to any acute care facility which occurs within 30 days of the discharge date of an earlier, eligible index admission.
Denominator Admissions for patients: Who are matched in the EHR/claims data; Enrolled in Medicare FFS; Aged 65 or over; Discharged from non federal acute care hospitals; Discharged alive; Not transferred to an acute care facility; Enrolled in Part A for 12 mo prior
Denominator Exclusions The measure excludes admissions for patients: Admitted to Prospective Payment System (PPS) exempt cancer hospitals Rationale: These hospitals care for a unique population of patients that cannot reasonably be compared to patients admitted to other hospitals Without at least 30 days of post discharge enrollment in FFS Medicare outcome cannot be assessed in this group since claims data are used to determine whether a patient was readmitted. Discharged against medical advice (AMA) Rationale: Providers did not have the opportunity to deliver full care and prepare the patient for discharge. Admitted for primary psychiatric diagnoses Rationale: Patients admitted for psychiatric treatment are typically cared for in separate psychiatric or rehabilitation centers that are not comparable to acute care hospitals. Admitted for rehabilitation Rationale: These admissions are not typically to an acute care hospital and are not for acute care. Admitted for medical treatment of cancer Rationale: These admissions have a different mortality and readmission profile than the rest of the Medicare population, and outcomes for these admissions do not correlate well with outcomes for other admissions. Patients with cancer admitted for other diagnoses or for surgical treatment of their cancer remain in the measure.
Rationale Currently, the Centers for Medicare & Medicaid Services (CMS) publicly reports risk-standardized readmission rates (RSRRs) for several conditions, including acute myocardial infarction (AMI), heart failure (HF), pneumonia, and hip and knee arthroplasty. CMS has also developed hospital readmission measures for stroke and chronic obstructive pulmonary disease (COPD). While it is helpful to assess readmission rates for specific groups of patients, these conditions account for only a small proportion of total readmissions. In 2013, CMS began publicly reporting a hospital-wide, all-condition readmission measure which provides a broader assessment of the quality of care at hospitals. This measure, which uses the same cohort and outcome definitions as the proposed eMeasure, includes 93% of admissions to acute care non-federal hospitals of Medicare Fee-for-Service patients over age 65 who are discharged alive to the non-acute care setting. The measure captures 92% of readmissions following eligible admissions. The proposed measure will build on the hospital-wide readmission measure by using clinical data elements derived from electronic health records (EHR), such as laboratory test values and vital signs, to risk adjust for patient-level factors that influence readmission. The proliferation of EHR systems and standardization of extraction and reporting of clinical data for quality measurement provide an opportunity to integrate these data into measures of hospital performance. This effort is also responsive to the preference expressed by the clinical community for the use of clinical data to adjust for patients' severity of illness in hospital outcome measures.
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 No
NQF Endorsement Status Endorsed
NQF ID 2879e  (NQF Website )
Last NQF Update 2020-02-10
Target Population Age 65+
Target Population Age (High) Not available
Target Population Age (Low) 65
Reporting Level Facility
Conditions
Subconditions
Care Settings Hospital Inpatient

  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 Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Milestone Effective Date Comments Links Other Data Actions
Considered 2014-12-01 Not available
MUC Year 2014
MUC ID X3701
Reference 1900-01-01 Not available
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 Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Links
Links Actions
Milestone Effective Date Comments Links Other Data Actions
Considered 2014-12-01 Not available
MUC ID X3701
MUC Year 2014
Reference 1900-01-01 Not available
There are no links associated with the measure at this time.