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

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

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

Slide 2

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

• 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

• 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.)

• 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; etc)

Slide 6

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)

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

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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

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

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

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