Hospitals that do well on publicly reported measures on discharge planning do not necessarily have fewer readmissions, according to analysis of Medicare data.
Dr. Ashish K. Jha, E. John Orav, and Dr. Arnold M. Epstein of the Harvard School of Public Health, Boston, studied the association between hospital performance on discharge planning measures and readmission rates for congestive heart failure and pneumonia, the two most common reasons Medicare patients are readmitted (N. Engl. J. Med. 2009;361:2637–45).
The authors looked at two data sets—Medicare's Hospital Quality Alliance program and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)—as well as other Medicare information profiling patients' discharge characteristics.
Conventional wisdom assumed that hospitals documenting discharge planning (only required for congestive heart failure) likely had fewer readmissions, Dr. Jha said in an interview. “The fact that there was no relationship between the chart-based measure and readmission rates was a little bit of a surprise.”
The authors compared data from 2,222 hospitals that had chart documentation and patient surveys, with 1,809 ospitals considered “nonreporting” because they did not provide data for both charts and patients.
The authors found no association between hospital size, location, or any other characteristics, and performance on the chart-based or patient-reported measures. They did find large variations in readmission rates, ranging from 17.5% to 29.6% for congestive heart failure and from 14.1% to 25.6% for pneumonia.
For heart failure readmission, unadjusted results found no difference based on a hospital's performance on chart-based discharge measures. When adjusted for institutional characteristics, hospitals in the highest quartile of performance for 30-day heart failure readmissions had rates that “were nearly identical” to those in the lowest quartile, according to the authors, the authors reported.
The authors found that, even if each facility improved performance to be on par with the hospitals in the 90th percentile on the patient-reported measure, there would be only 4,700 fewer congestive heart failure readmissions and 2,800 fewer pneumonia-related readmissions.
Public reporting has been associated with improvement in performance, but also carries a high administrative cost, said Dr. Jha. The study indicates that the chart-based measure may only be an indication of how well hospitals do in documentation, not performance, he said.
Dr. Jha reported he received consulting fees from UpToDate, which markets clinical decision support tools.