Key result
Adding social risk and clinical factors to a CMS-based model did not alter hospital performance rankings for 30-day stroke readmission rates, with all hospitals performing as expected.
Why the study?
Does the inclusion of social risk and clinical factors in hospital profiling models alter hospital rankings for 30-day stroke readmission in the VA?
Cohort
Yes
Does the inclusion of social risk and clinical factors in hospital profiling models alter hospital rankings for 30-day stroke readmission in the VA?
Adding social and clinical risk factors to CMS-based readmission models does not significantly change hospital performance rankings for stroke readmissions in the VA system.
Answers are grounded in this paper and cite their sources.
VA stroke readmission rankings remain unchanged after adding social and clinical factors; leaves open whether CMS models require adjustment outside the VA.
BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) and Veterans Health Administration (VA) will report 30-day stroke readmission rates as a measure of hospital quality. A national debate on whether social risk factors should be included in models developed for hospital profiling is ongoing. OBJECTIVE: To compare a CMS-based model of 30-day readmission with a more comprehensive model that includes measures of social risk (such as homelessness) or clinical factors (such as stroke severity and functional status). DESIGN: Data from a retrospective cohort study were used to develop a CMS-based 30-day readmission model that included age and comorbid conditions based on codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (model 1). This model was then compared with one that included administrative social risk factors (model 2). Finally, the CMS model (model 1) was compared with a model that included social risk and clinical factors from chart review (model 3). These 3 models were used to rank hospitals by 30-day risk-standardized readmission rates and examine facility rankings among the models. SETTING: Hospitals in the VA. PARTICIPANTS: Patients hospitalized with stroke in 2007. MEASUREMENTS: 30-day readmission rates. RESULTS: The 30-day readmission rate was 12.8%. The c-statistics for the 3 models were 0.636, 0.646, and 0.661, respectively. All hospitals were classified as performing "as expected" using all 3 models (that is, performance did not differ from the VA national average); therefore, the addition of detailed clinical information or social risk factors did not alter assessment of facility performance. LIMITATION: A predominantly male veteran cohort limits the generalizability of these findings. CONCLUSION: In the VA, more comprehensive models that included social risk and clinical factors did not affect hospital comparisons based on 30-day readmission rates. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.
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Keyhani et al. (2014) conducted a cohort in Stroke. Comprehensive readmission models including social risk and clinical factors vs. CMS-based readmission model (age and comorbid conditions) was evaluated on 30-day risk-standardized readmission rates and facility rankings. Adding social risk and clinical factors to a CMS-based model did not alter hospital performance rankings for 30-day stroke readmission rates, with all hospitals performing as expected.
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