Name | 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, adult surgical and adult medical. |
Interpretation | Lower 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 |
Latest Result Update Date |
11/2013 |
Indicator Results |
http://ourhealthsystem.ca/#!/indicators/006/returning-to-hospital |
Identifying Information | |
Name | 30-Day Overall Readmission |
Short/Other Names |
30-Day Readmission—Overall/Returning to Hospital |
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, adult surgical and adult medical. |
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 within six hours of 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 within 6 to 12 hours of 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 |
Calculation: Geographic Assignment |
Place of service |
Calculation: Type of Measurement |
Rate - per 100 |
Calculation: Adjustment Applied |
The following covariates are used in risk adjustment: |
Calculation: Method of Adjustment |
Logistic regression |
Denominator |
Description: Exclusions: |
Numerator |
Description: Exclusions: |
Background, Interpretation and Benchmarks | |
Rationale |
Hospital readmission rates can be influenced by a variety of factors, including poor hospital discharge planning and a lack of timely follow-up care. Monitoring unplanned/potentially avoidable readmissions within approximately one month of discharge can be useful for hospital quality surveillance and can be combined with other indicators to provide additional information. Data from the United States has shown that hospital readmissions contribute significantly to health care costs. 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. Medical Care Research & Review. 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. Medical 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. Journal of Hospital Medicine (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. New Zealand Medical Journal. 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: |
Geographic Coverage |
All provinces/territories |
Reporting Level/Disaggregation |
National, Province/Territory, Region, Facility |
Result Updates | |
Update Frequency |
Every year |
Latest Result Update Date |
11/2013 |
Indicator Results |
Web Tool: |
Updates |
Not Applicable |
Quality Statement | |
Caveats and Limitations |
It is important to note that the expected performance level of an institution in this indirect method of standardization of risk adjustment is based on how all institutions perform, because the number of expected cases is calculated based on regression models fitted on all cases from all hospitals. Furthermore, risk-adjustment modelling cannot entirely eliminate differences in patient characteristics among hospitals, because not all pre-admission influences are adjusted for; if left unadjusted for (due to reasons such as viability), hospitals with the sickest patients or that treat rare or highly specialized groups of patients could still score poorly. Finally, when interpreting risk-adjusted results, it is recommended that the hospital's result be compared with the Canada average. |
Trending Issues |
The definition of palliative records for Quebec was refined starting in 2011–2012 (see Denominator and Numerator sections for more details). |
Comments |
Not Applicable |