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Name
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Medical Patients Readmitted to Hospital
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Short/Other Names
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30-Day Medical Readmission

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Description
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This indicator measures the risk-adjusted rate of urgent readmission for the medical patient group

For further details, please see the General Methodology Notes.

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Interpretation
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Lower rates are desirable.
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HSP Framework Dimension
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Health System Outputs: Appropriate and effective

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Areas of Need
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Getting Better

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Geographic Coverage
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All provinces/territories

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Reporting Level/Disaggregation
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National, Province/Territory, Region, Facility, Neighbourhood Income Quintile,

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Indicator Results
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Accessing Indicator Results on Your Health System: In Depth

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Identifying Information
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<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>
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Name
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Medical Patients Readmitted to Hospital
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Short/Other Names
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30-Day Medical Readmission

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Indicator Description and Calculation
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Description
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This indicator measures the risk-adjusted rate of urgent readmission for the medical patient group

For further details, please see the General Methodology Notes.

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Calculation: Description
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Risk-adjusted rate = Observed number of readmissions ÷ Expected number of readmissions × Canadian average readmission rate

Unit of

Analysis

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

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

within

between 7

to

and 12 hours

of

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.

Notes

–For public reporting:

This indicator is calculated both

Regional and provincial/territorial results are calculated by place of residence

(regional and provincial results) and

; facility results are calculated by place of service

(facility results)

.

–For facility-level reporting: For episodes of care that involved transfers, readmissions were attributed to the last hospital from which the patient was discharged before readmission.

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Calculation: Geographic Assignment
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Place of residence or service

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Calculation: Type of Measurement
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Rate - per 100

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Calculation: Adjustment Applied
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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.

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Calculation: Method of Adjustment
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Logistic regression

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Denominator
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Description:
Number of medical episodes of care discharged between April 1 and March 1 of the fiscal year
Inclusions:
1. Episodes involving inpatient care (Facility Type Code = 1). An episode may start or end in a day surgery setting. Episodes that both start and end in day surgery settings are not included

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2.  Episodes involving medical inpatient care (major clinical category \[MCC\] partition code = D \[Diagnosis\]) 

3. Discharge between April 1 and March 1 of the following year (period of case selection ends on March 1 of the following year to allow for 30 days of follow-up)

4. Age at admission

20

18 years and older

5. Sex recorded as male or female

6. Canadian resident (Canadian postal code)

Exclusions:
1. Records with an invalid health card number

2. Records with an invalid

date of birth (non-Quebec records)

code for province issuing health card number

3. Records with an invalid admission date or time

4. Records with an invalid discharge date or time

5. Records with admission category of cadaveric donor or stillbirth (Admission Category Code = R or S)

6. Episodes with discharge as death

, self sign-out or patient not returning from a pass (

(DAD Discharge Disposition Code =

06, 07 or 12

07, 72*, 73*, 74*; NACRS Visit Disposition Code = 10, 11, 71*, 72*, 73*, 74*)

7. Presence of at least one record in the episode with MCC

17 (

of Mental Diseases and Disorders (MCC = 17)

8. Presence of at least one record in the episode with MCC

13 (

of Pregnancy and Childbirth (MCC = 13)

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9. Presence of at least one surgical record in the episode (MCC Partition Code = I \[Intervention\])

10. Presence of at least one record in the episode with palliative care (ICD-10-CA: Z51.5) coded as most responsible diagnosis (MRDx). For Quebec

MED-ÉCHO

data: Z51.5 coded as MRDx, or cancer (C00–C97) coded as MRDx and Z51.5 coded in any secondary diagnosis field

Note
*2018–2019 data onward

For an illustration of denominator selection, please refer to the flowchart in the General Methodology Notes document.

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Numerator
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Description:
Cases within the denominator with a non-elective readmission within 30 days of discharge after the index episode of care
Inclusions:
1. Emergent or urgent (non-elective) readmission to an acute care hospital (Admission Category Code = U and Facility Type Code = 1)

2. (Admission date on readmission record) − (Discharge date on the last record of the index episode of care) less than or equal to 30 days

Exclusions:
Presence of at least one record in the episode with one of the following:

1. Delivery (ICD-10-CA: O10–O16, O21–O29, O30–O37, O40–O46, O48, O60–O69, O70–O75, O85–O89, O90–O92, O95, O98, O99 with a sixth digit of 1 or 2; or Z37 recorded in any diagnosis field)

2. Chemotherapy for neoplasm (ICD-10-CA: Z51.1) as

MRDx

type (M), (1), (C), (W), (X) or (Y)

3. Admission for mental illness (MCC = 17)

4. Admission for palliative care (ICD-10-CA: Z51.5) coded as MRDx. For Quebec

MED-ÉCHO

data: Z51.5 coded as MRDx, or cancer (C00–C97) coded as MRDx and Z51.5 coded in any secondary diagnosis field

5. 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)

6. Records with an invalid admission date

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Background, Interpretation and Benchmarks
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Rationale
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Readmissions

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, effectiveness of the care transition and coordination, and the availability and use of effective community-based disease management programs. While not all urgent readmissions are avoidable, interventions during and after a hospitalization can be effective in reducing readmission rates.

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Interpretation
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Lower rates are desirable.

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HSP Framework Dimension
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Health System Outputs: Appropriate and effective

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Areas of Need
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Getting Better

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Targets/Benchmarks
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Not applicable

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References
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Ashton CM, Wray NP. A Conceptual Framework for the Study of Early Readmission as an Indicator of Quality of Care. Soc Sci Med 1996;(43):1533-1541.

Feudtner C. State-Level Child Health System Performance and the Likelihood of Readmission to Children's Hospitals. The Journal of Pediatrics. 2010;(157):98-102.

Jencks SF, et al. Rehospitalizations Among Patients in the Medicare Fee-for-Service Program. N Engl J Med 2009;(360):1418-1428.

Jiang HJ, Wier LM. All-Cause Hospital Readmissions Among Non-Elderly Medicaid Patients, 2007. HCUP Statistical Brief #89. Rockville, MD: AHRQ; 2010.

Liu S, Heaman M, Joesph KS, et al. Risk of Maternal Postpartum Readmission Associated With Mode of Delivery. Obstet Gynecol Int 2005;(105):836-842.

Stone J, Hoffman G J. Medicare Hospital Readmissions: Issues, Policy Options and PPACA. Washington, DC: CRS; 2010.

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Availability of Data Sources and Results
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Data Sources
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DAD, HMDB,

MED-ÉCHO,

NACRS

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Available Data Years
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Type of Year:
Fiscal
First Available Year:
2010
Last Available Year:

2014

2018

Table Row (tr)
Table Cell (td)
Geographic Coverage
Table Cell (td)

All provinces/territories

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Table Cell (td)
Reporting Level/Disaggregation
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National, Province/Territory, Region, Facility, Neighbourhood Income Quintile,

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Result Updates
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Update Frequency
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Every year

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

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Updates
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Not applicable

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Quality Statement
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Caveats and Limitations
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Not applicable

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Trending Issues
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For facility-level reporting: The definition of palliative records for Quebec was refined starting in 2011–2012 (see the Denominator and Numerator sections for more details).

Not applicable

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Comments
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Indicator results are also available in

–The publication
  • Publication (at regional, provincial/territorial and national levels
) (http://yourhealthsystem.cihi.ca/epub/?language=en)–Your
  • , calculated by place of residence), starting from 2010–2011

(https://www.cihi.ca/en/applications)
  • , updated monthly
starting from 2012–2013
  • (
facility, regional and provincial results all calculated by place of service)
  • results are available by both place of residence and place of service)
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