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Indicator Metadata

NameAll Patients Readmitted to Hospital
Short/Other Names

30-Day Overall Readmission

Description

This indicator measures the risk-adjusted rate of urgent readmissions within 30 days of discharge for episodes of care for the following patient groups: obstetric, patients age 19 and younger, surgical and medical.

For further details, please see the General Methodology Notes.

InterpretationLower rates are desirable.
HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility

Indicator Results

Accessing Indicator Results on Your Health System: In Depth

Identifying Information
NameAll Patients Readmitted to Hospital
Short/Other Names

30-Day Overall Readmission

Indicator Description and Calculation
Description

This indicator measures the risk-adjusted rate of urgent readmissions within 30 days of discharge for episodes of care for the following patient groups: obstetric, patients age 19 and younger, surgical and medical.

For further details, please see the General Methodology Notes.

Calculation: Description

Risk-adjusted rate for each facility = Observed number of readmissions for each facility ÷ Expected number of readmissions for the facility × Canadian average readmission rate

Unit of Analysis: Episode of care

An episode of care refers to all contiguous inpatient hospitalizations and same-day surgery visits. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if either of the following conditions is met:

a) An acute care hospitalization or a same-day surgery visit occurs less than seven hours after discharge from the previous acute care hospitalization or same-day surgery visit, regardless of whether the transfer is coded

b) An acute care hospitalization or same-day surgery visit occurs between 7 and 12 hours after discharge from the previous acute care hospitalization or same-day surgery visit, and at least one of the hospitalizations or visits has coded the transfer

For episodes of care that involved transfers, readmissions were attributed to the last hospital from which the patient was discharged before readmission.

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Rate - per 100

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
For a detailed list of covariates used in the model, please refer to the Model Specification document for the covariates used in risk adjustment for each of the four specific patient group readmission indicators for details (obstetric, patients age 19 and younger, surgical and medical).

Calculation: Method of Adjustment

Logistic regression

Denominator

Description:
Obstetric, patients age 19 and younger, surgical and medical episodes of care discharged between April 1 and March 1 of the fiscal year
Inclusions:
For details, please refer to Inclusions for each of the four specific patient group readmission indicators (obstetric, patients age 19 and younger, surgical and medical).

Exclusions:
For details, please refer to Exclusions for each of the four specific patient group readmission indicators (obstetric, patients age 19 and younger, surgical and medical).

Numerator

Description:
Cases within the denominator with an urgent readmission within 30 days of discharge after the index episode of care
Inclusions:
For details, please refer to Inclusions for each of the four specific patient group readmission indicators (obstetric, patients age 19 and younger, surgical and medical).

Exclusions:
For details, please refer to Exclusions for each of the four specific patient group readmission indicators (obstetric, patients age 19 and younger, surgical and medical).

Background, Interpretation and Benchmarks
Rationale

Urgent readmissions to acute care facilities are increasingly being used to measure institutional or regional quality of care and care coordination.

Readmission rates can be influenced by a variety of factors, including the quality of inpatient and outpatient care, the effectiveness of the care transition and coordination, and the availability and use of effective disease management community-based programs. While not all unplanned readmissions are avoidable, interventions during and after a hospitalization can be effective in reducing readmission rates.

Interpretation

Lower rates are desirable.

HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

Friedman B, Basu J. The rate and cost of hospital readmissions for preventable conditions. Med Care Res Rev June, 2004;61(2):225-240.

Halfon P, Eggli Y, Pretre-Rohrbach I, Meylan D, Marazzi A, Burnand B. Validation of the potentially avoidable hospital readmission rate as a routine indicator of the quality of hospital care. Med Care November, 2006;44(11):972-981.

Misky GJ, Wald HL, Coleman EA. Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up. J Hosp Med (Online) September, 2010;5(7):392-397.

Rumball-Smith J, Hider P. The validity of readmission rate as a marker of the quality of hospital care, and a recommendation for its definition. Review 39 refs. N Z Med J February 13, 2009;122(1289):63-70.

Shepperd S, McClaran J, Phillips CO, et al. Discharge planning from hospital to home. Review 83 refs. Update of Cochrane Database Syst Rev. 2004;(1):CD000313; PMID: 14973952. Cochrane Database of Systematic Reviews (1):CD000313, 2010. 2010;(1):CD000313.

Availability of Data Sources and Results
Data Sources

DAD, HMDB, NACRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2012
Last Available Year:
2016

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Updates

Not applicable

Quality Statement
Caveats and Limitations

Not applicable

Trending Issues

Not applicable

Comments

Indicator results are also available in
–Your Health System: In Brief (http://yourhealthsystem.cihi.ca/inbrief/?lang=en#!/indicators/006/all-patients-readmitted-to-hospital)
–Your Health System: Insight (https://www.cihi.ca/en/applications), updated monthly starting from 2013–2014