National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- Adverse Events (2)
- Cardiovascular Conditions (4)
- Children/Adolescents (1)
- Disparities (1)
- Elderly (1)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Health Insurance (1)
- Heart Disease and Health (5)
- Hospital Discharge (1)
- Hospitalization (2)
- (-) Hospital Readmissions (13)
- (-) Hospitals (13)
- Inpatient Care (1)
- Medicare (5)
- Mortality (3)
- Nursing Homes (1)
- Patient Safety (1)
- Payment (4)
- (-) Provider Performance (13)
- Quality Improvement (1)
- Quality Indicators (QIs) (1)
- Quality Measures (2)
- Quality of Care (6)
- Respiratory Conditions (1)
- Sepsis (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 13 of 13 Research Studies DisplayedNash KA, Weerahandi H, Yu H
Measuring equity in readmission as a distinct assessment of hospital performance.
This study examined the measure of equitable readmissions in hospitals as developed by the Centers for Medicare & Medicaid Services (CMS). Objectives were to define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). The authors used data from a cross-section of hospitals who were eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. Of 4638 hospitals, they found that 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of these eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% vs 3.3%, race, 7.6% vs 9.3%), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size. In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions, and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions, and there was no relationship between cost and value, and equity.
AHRQ-funded; HS022882.
Citation: Nash KA, Weerahandi H, Yu H .
Measuring equity in readmission as a distinct assessment of hospital performance.
JAMA 2024 Jan 9; 331(2):111-23. doi: 10.1001/jama.2023.24874..
Keywords: Hospital Readmissions, Hospitals, Provider Performance, Disparities
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N and Rodrick D
Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality and readmission for patients with heart failure.
Researchers sought to evaluate the association between hospital performance on mortality and readmission with hospital performance on safety adverse event rates. Their cross-sectional study linked patient-level adverse events data from the Medicare Patient Safety Monitoring System to hospital-level, heart failure (HF)-specific, 30-day, all-cause mortality and readmissions data from CMS. The study included data on over 39,000 patients with HF from over 3000 hospitals. Patients admitted with HF to hospitals with high 30-day, all-cause mortality and readmission rates had a higher risk of in-hospital adverse events. The researchers concluded that there might be common quality issues among the measure concepts in these hospitals that produce poor performance for patients with HF.
AHRQ-funded; AHRQ-authored; 290201800005C.
Citation: Wang Y, Eldridge N, Metersky ML .
Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality and readmission for patients with heart failure.
Circ Cardiovasc Qual Outcomes 2023 Jul; 16(7):e009573. doi: 10.1161/circoutcomes.122.009573..
Keywords: Hospitals, Hospital Readmissions, Heart Disease and Health, Cardiovascular Conditions, Adverse Events, Provider Performance
Jacobs PD, Basu J
AHRQ Author: Jacobs PD, Basu J
Medicare Advantage and postdischarge quality: evidence from hospital readmissions.
This study compared relative readmission rates for beneficiaries enrolled in Medicare Advantage (MA) and traditional Medicare (TM). HCUP State Inpatient Databases data for 4 states was used from 2009 and 2014. The outcome compared was the probability of a hospital readmission within 30 days of an index admission. There were significantly lower all-cause readmission rates among MA enrollees relative to those in TM in both 2009 and 2014, but MA enrollment was not associated with an increased reduction in readmission rates relative to TM during that time period.
AHRQ-authored
Citation: Jacobs PD, Basu J .
Medicare Advantage and postdischarge quality: evidence from hospital readmissions.
Am J Manag Care 2020 Dec;26(12):524-29. doi: 10.37765/ajmc.2020.88540..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Medicare, Hospital Readmissions, Hospitals, Quality of Care, Provider Performance
Mohr NM, Zebrowski AM, Gaieski DF
Inpatient hospital performance is associated with post-discharge sepsis mortality.
The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes. Sepsis hospitalization survivors among age-qualifying Medicare beneficiaries were followed for 180 days post-discharge; mortality, readmissions, and new admission to skilled nursing facilities were measured. Findings showed that hospitals with the highest risk-adjusted sepsis inpatient mortality also had higher post-discharge mortality and increased readmissions, suggesting that post-discharge complications were a modifiable risk that may be affected during inpatient care. Recommendations for future work include seeking to elucidate inpatient and healthcare practices that can reduce sepsis post-discharge complications.
AHRQ-funded; HS023614; HS025753.
Citation: Mohr NM, Zebrowski AM, Gaieski DF .
Inpatient hospital performance is associated with post-discharge sepsis mortality.
Crit Care 2020 Oct 27;24(1):626. doi: 10.1186/s13054-020-03341-3..
Keywords: Sepsis, Mortality, Hospital Discharge, Hospitals, Provider Performance, Quality of Care, Inpatient Care, Hospital Readmissions
Spatz ES, Bernheim SM, Horwitz LI
Community factors and hospital wide readmission rates: does context matter?
The purpose of this study was to estimate the influence of community factors on the Centers for Medicare & Medicaid Services risk-standardized hospital-wide readmission measure (HWR)-a quality performance measure in the U.S. The investigators concluded that readmissions for a wide range of clinical conditions were influenced by factors relating to the communities in which patients reside.
AHRQ-funded; HS022882.
Citation: Spatz ES, Bernheim SM, Horwitz LI .
Community factors and hospital wide readmission rates: does context matter?
PLoS One 2020 Oct 23;15(10):e0240222. doi: 10.1371/journal.pone.0240222..
Keywords: Hospital Readmissions, Hospitals, Provider Performance, Quality Measures, Quality of Care
Hoffman GJ, Yakusheva O
Association between financial incentives in Medicare's hospital readmissions reduction program and hospital readmission performance.
This study compared the outcome of penalties versus rewards to prevent hospital readmission in Medicare’s Hospital Readmissions Reduction Program (HRRP). This retrospective cohort study used Medicare readmissions data from 2823 US short-term acute care hospitals participating in HRRP. Data from pre-HRRP in 2016 was compared with 2016-2019 3-year follow-up readmission performance classified by tertile of hospitals using baseline marginal incentives for 5 HRRP-targeted conditions: acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, and hip and/or knee surgery. Of the 2823 hospitals participating in HRRP from baseline to follow-up, 81% had more than 1 excess readmission for 1 or more applicable condition and 19% did not. Financial incentives ranged from a mean range of $8762 to $58,158 per 1 avoided readmission. Hospitals with greater incentives for readmission avoidance had greater decreases than hospitals with smaller incentives. An additional $5000 in the incentive amount was associated with up to a 26% decrease in readmissions. The findings suggest that incentives work better than penalties to reduce hospital readmissions for those 5 conditions.
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Yakusheva O .
Association between financial incentives in Medicare's hospital readmissions reduction program and hospital readmission performance.
JAMA Netw Open 2020 Apr;3(4):e202044. doi: 10.1001/jamanetworkopen.2020.2044..
Keywords: Medicare, Hospital Readmissions, Provider Performance, Payment, Health Insurance, Hospitals
Kim KL, LI L, Kuang M
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
The objective of this study was to investigate the association between changes in hospital referral patterns to skilled nursing facilities (SNFs) and Hospital Readmissions Reduction Program (HRRP) penalty pressure. Results showed that HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNFs differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
AHRQ-funded; HS022882.
Citation: Kim KL, LI L, Kuang M .
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
Med Care 2019 Sep;57(9):695-701. doi: 10.1097/mlr.0000000000001169..
Keywords: Hospitals, Nursing Homes, Hospital Readmissions, Payment, Provider Performance
Chukmaitov A, Harless DW, Bazzoli GJ
Preventable hospital admissions and 30-day all-cause readmissions: does hospital participation in accountable care organizations improve quality of care?
This study evaluates quality performance of hospitals participating in Medicare Shared Savings and Pioneer Accountable Care Organization (ACO) programs relative to nonparticipating hospitals. The authors studied preventable hospitalizations for conditions sensitive to high-quality ambulatory care and 30-day all-cause readmissions potentially influenced by hospital care. A decrease was found in preventable hospitalizations for COPD and asthma and for diabetes complications for ACO participating hospitals, but no significant differences for preventable chronic heart failure hospitalizations and 30-day readmissions.
AHRQ-funded; HS023332.
Citation: Chukmaitov A, Harless DW, Bazzoli GJ .
Preventable hospital admissions and 30-day all-cause readmissions: does hospital participation in accountable care organizations improve quality of care?
Am J Med Qual 2019 Jan/Feb;34(1):14-22. doi: 10.1177/1062860618778786..
Keywords: Hospital Readmissions, Hospitals, Quality of Care, Provider Performance, Hospitalization
Meddings J, Smith SN, Hofer TP
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
This study examined the discrepancy of ratings with hospitals with low readmission grades for heart failure (HF) and acute myocardial infarction (AMI) on the Hospital Compare website, yet received penalties for excessive readmissions under the hospital Readmissions Reduction Program. A retrospective data analysis was conducted of 2956 hospitals that had publicly reported HF grades on Hospital Compare. Of those, 92% were graded as “no different” than the national rate for HD readmissions, yet included 48.6% that were scored as having excessive HF admissions and 87% received an overall readmission penalty. Of the 120 hospitals graded as “better”, none were scored as having excessive HF readmissions and 50% were penalized. There were similar results for AMI.
AHRQ-funded; HS018334; HS019767.
Citation: Meddings J, Smith SN, Hofer TP .
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
Am J Manag Care 2018 Dec;24(12):e399-e403..
Keywords: Medicare, Hospital Readmissions, Heart Disease and Health, Hospitals, Quality of Care, Cardiovascular Conditions, Provider Performance, Payment
Huckfeldt P, Escarce J, Wilcock A
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
After announcement and implementation of the Medicare Hospital Readmissions Reduction Program (HRRP), 30-day readmissions declined rapidly among seniors with heart failure (HF) while 30-day mortality rose. This raised questions about whether the policy was responsible, because lower HF readmission rates have historically been associated with higher mortality. In this study, the investigators compared trends in heart failure (HF) mortality at penalized and nonpenalized hospitals nationally.
AHRQ-funded; HS024284.
Citation: Huckfeldt P, Escarce J, Wilcock A .
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
J Am Coll Cardiol 2018 Nov 13;72(20):2539-40. doi: 10.1016/j.jacc.2018.08.2174..
Keywords: Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Medicare, Hospitals, Provider Performance, Payment
Kaiser SV, Lam R, Joseph GB
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
Researcher sought to determine if a National Quality Forum (NQF)-endorsed measure for pediatric lower respiratory illness (LRI) 30-day readmission rates can meaningfully identify high- and low-performing hospitals. Subjects were children with LRI (bronchiolitis, influenza, or pneumonia as primary diagnosis, or with an LRI as a secondary diagnosis with a primary diagnosis of respiratory failure, sepsis, bacteremia, or asthma) from all hospital admissions in California from 2012 to 2014. The researchers were unable to identify meaningful variation in hospital performance without broadening the metric definition and merging multiple years of data. They recommend that utilizers of pediatric-quality measures consider modifying metrics to better evaluate the quality of pediatric care at low-volume hospitals.
AHRQ-funded; HS024385; HS022835; HS024592; HS025297.
Citation: Kaiser SV, Lam R, Joseph GB .
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
J Hosp Med 2018 Nov;13(11):737-42. doi: 10.12788/jhm.2988..
Keywords: Children/Adolescents, Respiratory Conditions, Provider Performance, Hospital Readmissions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care, Quality Improvement
Davis JD, Olsen MA, Bommarito K
All-payer analysis of heart failure hospitalization 30-day readmission: comorbidities matter.
In this study, the researchers investigated readmission characteristics and the magnitude of 30-day hospital readmissions after hospital discharge for heart failure using the Healthcare Cost and Utilization Project State Inpatient Databases (SID). They found in this large all-payer cohort, ∼70% of 30-day readmissions were for non-heart failure causes, and the median time to readmission was 12 days.
AHRQ-funded; HS019455.
Citation: Davis JD, Olsen MA, Bommarito K .
All-payer analysis of heart failure hospitalization 30-day readmission: comorbidities matter.
Am J Med 2017 Jan;130(1):93.e9-93.e28. doi: 10.1016/j.amjmed.2016.07.030..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Hospitalization, Hospitals, Provider Performance
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N
Association between hospital performance on patient safety and 30-day mortality and unplanned readmission for Medicare fee-for-service patients with acute myocardial infarction.
The researchers studied the relationship between hospital performance on adverse event rates and hospital performance on 30-day mortality and unplanned readmission rates for Medicare fee-for-service patients hospitalized for acute myocardial infarction (AMI). They found that for Medicare fee-for-service patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30-day all-cause mortality and on unplanned readmissions.
AHRQ-authored.
Citation: Wang Y, Eldridge N, Metersky ML .
Association between hospital performance on patient safety and 30-day mortality and unplanned readmission for Medicare fee-for-service patients with acute myocardial infarction.
J Am Heart Assoc 2016 Jul;5(7):pii: e003731. doi: 10.1161/jaha.116.003731.
.
.
Keywords: Adverse Events, Hospital Readmissions, Hospitals, Medicare, Mortality, Heart Disease and Health, Patient Safety, Provider Performance