Title

Impact of Risk Adjustment for Socioeconomic Status on Risk-adjusted Surgical Readmission Rates

UMMS Affiliation

UMass Worcester Prevention Research Center; Department of Medicine, Division of Preventive and Behavioral Medicine

Date

4-1-2016

Document Type

Article

Disciplines

Health Services Administration | Health Services Research | Surgery

Abstract

OBJECTIVE: To assess whether differences in readmission rates between safety-net hospitals (SNH) and non-SNHs are due to differences in hospital quality, and to compare the results of hospital profiling with and without SES adjustment.

BACKGROUND: In response to concerns that quality measures unfairly penalizes SNH, NQF recently recommended that performance measures adjust for socioeconomic status (SES) when SES is a risk factor for poor patient outcomes.

METHODS: Multivariate regression was used to examine the association between SNH status and 30-day readmission after major surgery. The results of hospital profiling with and without SES adjustment were compared using the CMS Hospital Compare and the Hospital Readmissions Reduction Program (HRRP) methodologies.

RESULTS: Adjusting for patient risk and SES, patients admitted to SNHs were not more likely to be readmitted compared with patients in in non-SNHs (AOR 1.08; 95% CI:0.95-1.23; P = 0.23). The results of hospital profiling based on Hospital Compare were nearly identical with and without SES adjustment (ICC 0.99, kappa 0.96). Using the HRRP threshold approach, 61% of SNHs were assigned to the penalty group versus 50% of non-SNHs. After adjusting for SES, 51% of SNHs were assigned to the penalty group.

CONCLUSIONS: Differences in surgery readmissions between SNHs and non-SNHs are due to differences in the patient case mix of low-SES patients, and not due to differences in quality. Adjusting readmission measures for SES leads to changes in hospital ranking using the HRRP threshold approach, but not using the CMS Hospital Compare methodology. CMS should consider either adjusting for the effects of SES when calculating readmission thresholds for HRRP, or replace it with the approach used in Hospital Compare.

Rights and Permissions

Citation: Ann Surg. 2016 Apr;263(4):698-704. doi: 10.1097/SLA.0000000000001363. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Keywords

outcome assessment, patient readmission, quality indicators

PubMed ID

26655922