Readmissions to the Acute Care Setting: A Broader Scope Changes the Picture

Slide presentation from the AHRQ 2010 conference.

On September 27, 2010, Claudia Steiner made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (7 MB). Free PowerPoint® Viewer (Plugin Software Help).


Slide 1

Readmissions to the Acute Care Setting: A Broader Scope Changes the Picture

Readmissions to the Acute Care Setting: A Broader Scope Changes the Picture

Claudia Steiner, M.D., M.P.H.
Agency for Healthcare Research and Quality
Annual Meeting—September 27, 2010

Slide 2

Session Staff

Session Staff

  • William Spector, PhD; Health Services Researcher, CDOM / AHRQ
  • David Brousseau, MD, MS; Professor Pediatrics, Medical College of Wisconsin
  • Bernard Friedman, PhD; Economist, CDOM / AHRQ
  • Joanna Jiang, PhD; Research Scientist, CDOM / AHRQ

Slide 3

Objectives

Objectives

  • Robust discussion about analytic considerations when conducting readmission projects.
  • The Healthcare Cost and Utilization Project (HCUP):
    • A data resource to conduct readmission and revisit analyses.
  • Learn a little about several interesting content areas.

Slide 4

Readmissions

Readmissions

  • Key considerations:
    • Choice of database?
    • Inpatient only or other acute care?
    • Single year, multi-year, partial year?
      • Consistent patient identifier?
    • Selection of cases:
      • By procedure or condition?
      • By patient characteristic:
        • Age, payer, gender

Slide 5

Readmissions (cont.)

Readmissions (cont.)

  • Key considerations:
    • Definition of readmission
      • Same condition
      • Related condition
      • Any condition
    • How to handle multiple records:
      • Single or multiple index
      • "Clean period"
      • Deaths
      • Transfers
      • Same day visits (IP-IP; ED-IP; ect)

Slide 6

Readmissions (cont.)

Readmissions (cont.)

  • Key considerations:
    • Time between readmission / revisit
      • 7, 14, 30, 60, 90, 180 days
    • Categorizing characteristics over time:
      • Age
      • Payer
      • Type of hospital
    • Risk adjustment
      • Regression analyses
      • Severity software

Slide 7

Healthcare Cost and Utilization Project (HCUP)

Healthcare Cost and Utilization Project (HCUP)

Image: The HCUP logo is shown.

The Largest Collection of Multi-Year, All-Payer, Encounter-Level:

Inpatient
Emergency Department

Ambulatory Surgery

Hospital-Based Administrative Data

Slide 8

HCUP Database Participation 2009 Data Year

HCUP Database Participation 2009 Data Year

Non-participating

  • ID
  • MT
  • ND
  • MS
  • AL

Partners Providing Inpatient Data Only

  • WA
  • OR
  • NV
  • WY
  • NM
  • TX
  • LA
  • AR
  • IL
  • WV
  • VA
  • PA

Partners Providing Inpatient & Ambulatory Surgery Data

  • CO
  • OK
  • MI

Partners Providing Inpatient & Emergency Department Data

  • AZ
  • RI
  • MA

Partners Providing Inpatient, Ambulatory Surgery, & Emergency Department Data

  • CA
  • UT
  • SD
  • NE
  • KS
  • MN
  • IA
  • MO
  • WI
  • IN
  • KY
  • TN
  • OH
  • GA
  • FL
  • SC
  • NC
  • MD
  • DE
  • NJ
  • NY
  • CT
  • VT
  • NH

Slide 9

Current HCUP Partners

Current HCUP Partners

  • Arizona Department of Health Services
  • Arkansas Department of Health
  • California Office of Statewide Health Planning & Development
  • Colorado Hospital Association
  • Connecticut Integrated Health Information (Chime, Inc.)
  • Florida Agency for Health Care Administration
  • Georgia Hospital Association
  • Hawaii Health Information Corporation
  • Illinois Department of Public Health
  • Indiana Hospital & Health Association
  • Iowa Hospital Association
  • Kansas Hospital Association

Slide 10

Current HCUP Partners

Current HCUP Partners

  • Kentucky Cabinet for Health and Family Services
  • Louisiana Department of Health and Hospitals
  • Maine Health Data Organization
  • Maryland Health Services Cost Review Commission
  • Massachusetts Division of Health Care Finance and Policy
  • Michigan Health & Hospital Association
  • Minnesota Hospital Association
  • Missouri Hospital Industry Data Institute
  • Nebraska Hospital Association
  • Nevada Division of Health Care Financing and Policy, Department of Health and Human Services
  • New Hampshire Department of Health & Human Services

Slide 11

Current HCUP Partners

Current HCUP Partners

  • New Jersey Department of Health and Senior Services
  • New Mexico Health Policy Commission
  • New York State Department of Health
  • North Carolina Department of Health and Human Services
  • Ohio Hospital Association
  • Oklahoma Health Care Information Center for Health Statistics
  • Oregon Association of Hospitals and Health Systems
  • Pennsylvania Health Care Cost Containment Council
  • Rhode Island Department of Health
  • South Carolina State Budget & Control Board
  • South Dakota Association of Health Care Organizations
  • Tennessee Hospital Association

Slide 12

Current HCUP Partners

Current HCUP Partners

  • Texas Department of State Health Services
  • Utah Department of Health
  • Vermont Association of Hospitals and Health Systems
  • Virginia Health Information
  • Washington State Department of Health
  • West Virginia Health Care Authority
  • Wisconsin Department of Health and Family Services
  • Wyoming Hospital Association

Slide 13

HCUP State Databases

HCUP State Databases

  • SID—All inpatient hospital discharge data (including those admissions that started in the ED) from participating HCUP States
  • SASD—Ambulatory surgery data (hospital based and some freestanding) from participating HCUP States
  • SEDD—Emergency department data (treat and release) from participating HCUP States

Slide 14

Readmissions: Hospitalizations for Same Patient

Readmissions: Hospitalizations for Same Patient

  • 1 hospital admission
  • 2 hospital admissions
  • 3 hospital admissions from 2 unique people in SID

Readmissions: Sequential hospital admissions for a (un)related reason, and usually within a specific time frame.

Slide 15

Revisits: Multiple visits for same patient across hospital settings

Revisits: Multiple visits for same patient across hospital settings

  • 1 hospital admission + 2 ED visits
  • 2 hospital admissions + 1 ED visit
  • 3 hospital admissions + 3 ED visits from 2 unique people

Source of the data is from 2009 SID and 2009 SEDD

Revisits: Multiple health care encounters for a particular patient for related or unrelated conditions.

Slide 16

Encrypted Patient Identifier

Encrypted Patient Identifier

PNUM_R
Person number (re-identified)

Unique Patient Number for Each Patient

Images of 4 individuals are shown below.

Slide 17

HCUP Revisit File Data Elements

HCUP Revisit File
Data Elements

  1. VisitLink
    • Linkage variable for all events associated with a unique patient.
    • Based on a unique combination of person numbers, date of birth, and gender.
  2. daysToEvent
    • Number of days from a randomly chosen "start date" to the admission date for a specific health care visit for an individual.

Slide 18

HCUP Databases Can Be Combined to Provide a More Complete Picture

HCUP Databases Can Be Combined to Provide a More Complete Picture

The HCUP Revisit Files allow researchers to study multiple patient visits to the acute care setting, regardless of whether the visit resulted in hospital admission

Current as of December 2010
Internet Citation: Readmissions to the Acute Care Setting: A Broader Scope Changes the Picture. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/steiner/index.html