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

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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

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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

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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

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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

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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 ect)

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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

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Healthcare Cost and Utilization Project
(HCUP) THE LARGEST COLLECTION OF
MULTI-YEAR, ALL-PAYER, ENCOUNTER-LEVEL INPATIEN
T EMERGENCY DEPARTMENT AMBULATORY
SURGERY HOSPITAL-BASED ADMINISTRATIVE DATA
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HCUP Database Participation 2009 Data Year
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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

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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 Massachuset
ts Division of Health Care Finance and
Policy Michigan Health Hospital
Association Minnesota Hospital Association Missour
i 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
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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

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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

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HCUP State Databases
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Readmissions Hospitalizations for Same Patient
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Revisits Multiple visits for same patient across
hospital settings

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Encrypted Patient Identifier
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HCUP Revisit FileData Elements

• visitLink
• Linkage variable for all events associated with a
  unique patient
• Based on a unique combination of person numbers,
  date of birth, and gender
• daysToEvent
• Number of days from a randomly chosen "start
  date" to the admission date for a specific health
  care visit for an individual.

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HCUP Databases Can Be Combined to Provide a More
Complete Picture