New AHRQ Database Tracks Hospital Readmission Rates
If you hear health services researchers talking about a "nerd," you shouldn't necessarily assume they're talking about themselves. For now, they're probably referring to a new database.
The database in question—the Nationwide Readmissions Database or NRD (hence the nickname, "nerd")—is the newest addition to AHRQ's Healthcare Cost and Utilization Project (HCUP). The NRD is the first all-payer nationwide database that supports analysis of hospital readmissions. It's a comprehensive, "deep-dive" national source of readmissions data, making it an invaluable resource to understand this critically important health policy issue. Put simply, this is the first all-payer database in the country that will let you track readmissions.
For those of you unfamiliar with HCUP, it's a group of related databases that captures information extracted from administrative data—or a patient's billing record after he or she is discharged from the hospital. HCUP captures data from all kinds of insurers, including Medicare, Medicaid, commercial payers, and the uninsured, and comprises the largest and most robust database available regarding the care provided to patients in U.S. hospitals.
The NRD is a significant addition to HCUP, because it will help researchers better understand how and why many people return to the hospital shortly after they've been discharged. The lack of this information across payers has been a major gap in health care data at a critical time for policy decisions.
Researchers, health services professionals, and policymakers (in other words, health care policy and data nerds) will now be able to use the NRD to analyze national readmission rates, reasons for returning to the hospital for care, and the hospital costs for discharges with and without readmissions. It gives researchers and policymakers data from which they can base inquiries into what causes readmissions, how much readmissions cost, and areas to focus on in order to reduce readmissions.
Why is this important? Readmissions place patients at greater risk of complications and healthcare-associated infections. And, they're costly; nearly one in five of all hospital patients covered by Medicare are readmitted within 30 days, accounting for $15 billion a year. The NRD can help us quantify and understand these readmissions covered by other payers as well in a deeper, richer, and more complete way.
We've already put the NRD to good use by analyzing trends in readmissions for four major health conditions—congestive heart failure, chronic obstructive pulmonary disease (COPD), heart attack, and pneumonia. According to the resulting Statistical Brief, there were nearly 500,000 readmissions totaling $6.8 billion in aggregate hospital costs for those four conditions in 2013.
We also learned from analyzing the database that from 2009 to 2013, Medicare had better trend lines than other payers. For instance, the readmission rate for pneumonia decreased 6 percent for patients covered by Medicare, while readmissions for pneumonia rose 11 percent for patients covered by Medicaid and 13 percent for uninsured patients. Overall, the cumulative percentage change in readmission rates for those four conditions fell 7.9 percent for Medicare patients, outpacing the rate reduction of 5.8 percent for privately insured patients and 4.0 percent for uninsured patients; readmissions for the four conditions actually rose for Medicaid patients, by 3.5 percent.
Why is this? We aren't certain—these analyses using the NRD tells us what happened, but not why. However, we do know that the greater Medicare readmission rate reductions coincide with changes in Medicare payment policy penalizing excess readmissions and with the Partnership for Patients initiative, which aims to reduce hospital readmissions.
This level of detail around readmissions is exciting stuff for health services researchers. We now have a resource we can rely on so policymakers can formulate proposals and other improvement efforts that hospitals can use to reduce their readmissions and keep patients healthier and safer. And that's something you don't have to be a nerd to understand.
Dr. Steiner is Director, Division of Healthcare Delivery Data, Measures and Research with AHRQ's Center for Delivery, Organization, and Markets.
Page originally created November 2015