Development and Validation of an Algorithm to Identify Planned Readmissions From Claims Data. Issue 10 (7th July 2015)

• Record Type: Journal Article
• Authors: Horwitz, Leora I.; Grady, Jacqueline N.; Cohen, Dorothy B.; Lin, Zhenqiu; Volpe, Mark; Ngo, Chi K.; Masica, Andrew L.; Long, Theodore; Wang, Jessica; Keenan, Megan; Montague, Julia; Suter, Lisa G.; Ross, Joseph S.; Drye, Elizabeth E.; Krumholz, Harlan M.; Bernheim, Susannah M.
• Is Part Of: Journal of hospital medicine. Volume 10:Issue 10(2015)
• Page Start: 670
• Page End: 677
• Publication Date: 2015-07-07
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2416
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2416-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>It is desirable not to include planned readmissions in readmission measures because they represent deliberate, scheduled care.</p> </sec> <sec id="jhm2416-sec-0002" sec-type="section"> <title>OBJECTIVES</title> <p>To develop an algorithm to identify planned readmissions, describe its performance characteristics, and identify improvements.</p> </sec> <sec id="jhm2416-sec-0003" sec-type="section"> <title>DESIGN</title> <p>Consensus‐driven algorithm development and chart review validation study at 7 acute‐care hospitals in 2 health systems.</p> </sec> <sec id="jhm2416-sec-0004" sec-type="section"> <title>PATIENTS</title> <p>For development, all discharges qualifying for the publicly reported hospital‐wide readmission measure. For validation, all qualifying same‐hospital readmissions that were characterized by the algorithm as planned, and a random sampling of same‐hospital readmissions that were characterized as unplanned.</p> </sec> <sec id="jhm2416-sec-0005" sec-type="section"> <title>MEASUREMENTS</title> <p>We calculated weighted sensitivity and specificity, and positive and negative predictive values of the algorithm (version 2.1), compared to gold standard chart review.</p> </sec> <sec id="jhm2416-sec-0006" sec-type="section"> <title>RESULTS</title> <p>In consultation with 27 experts, we developed an algorithm that characterizes 7.8% of readmissions as planned. For validation we reviewed 634 readmissions. The weighted sensitivity of the algorithm was 45.1% overall, 50.9% in large teaching centers and 40.2% in smaller community hospitals. The weighted specificity was 95.9%, positive predictive value was 51.6%, and negative predictive value was 94.7%. We identified 4 minor changes to improve algorithm performance. The revised algorithm had a weighted sensitivity 49.8% (57.1% at large hospitals), weighted specificity 96.5%, positive predictive value 58.7%, and negative predictive value 94.5%. Positive predictive value was poor for the 2 most common potentially planned procedures: diagnostic cardiac catheterization (25%) and procedures involving cardiac devices (33%).</p> </sec> <sec id="jhm2416-sec-0007" sec-type="section"> <title>CONCLUSIONS</title> <p>An administrative claims‐based algorithm to identify planned readmissions is feasible and can facilitate public reporting of primarily unplanned readmissions. <italic>Journal of Hospital Medicine</italic> 2015;10:670–677. © 2015 Society of Hospital Medicine.</p> </sec> </abstract>