30-Day Overall Readmission

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.

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 7 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

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

Place of service

Rate - per 100

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).

Logistic regression

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).

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).

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.

Lower rates are desirable.

Health System Outputs: Appropriate and effective

Getting Better

Not applicable

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.

DAD, HMDB, NACRS

Type of Year:
Fiscal
First Available Year:
2010
Last Available Year:
2014

All provinces/territories

National, Province/Territory, Region, Facility

Every year

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

Not applicable

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.

The definition of palliative records for Quebec was refined starting in 2011–2012 (see Denominator and Numerator sections for more details).

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 2012–2013