Health Policy Manag.  2015 Sep;25(3):197-206. 10.4332/KJHPA.2015.25.3.197.

Developing a Hospital-Wide All-Cause Risk-Standardized Readmission Measure Using Administrative Claims Data in Korea: Methodological Explorations and Implications

• Kim M
• Kim H
• Hwang SH

• KMID: 2165251
• DOI: http://doi.org/10.4332/KJHPA.2015.25.3.197

Abstract

BACKGROUND
The purpose of this study was to propose a method for developing a measure of hospital-wide all-cause risk-standardized readmissions using administrative claims data in Korea and to discuss further considerations in the refinement and implementation of the readmission measure.
METHODS
By adapting the methodology of the United States Center for Medicare & Medicaid Services for creating a 30-day readmission measure, we developed a 6-step approach for generating a comparable measure using Korean datasets. Using the 2010 Korean National Health Insurance (NHI) claims data as the development dataset, hierarchical regression models were fitted to calculate a hospital-wide all-cause risk-standardized readmission measure. Six regression models were fitted to calculate the readmission rates of six clinical condition groups, respectively and a single, weighted, overall readmission rate was calculated from the readmission rates of these subgroups. Lastly, the case mix differences among hospitals were risk-adjusted using patient-level comorbidity variables. The model was validated using the 2009 NHI claims data as the validation dataset.
RESULTS
The unadjusted, hospital-wide all-cause readmission rate was 13.37%, and the adjusted risk-standardized rate was 10.90%, varying by hospital type. The highest risk-standardized readmission rate was in hospitals (11.43%), followed by general hospitals (9.40%) and tertiary hospitals (7.04%).
CONCLUSION
The newly developed, hospital-wide all-cause readmission measure can be used in quality and performance evaluations of hospitals in Korea. Needed are further methodological refinements of the readmission measures and also strategies to implement the measure as a hospital performance indicator.

Keyword

Patient readmission; Quality indicators; Risk-adjustment; Hospital

MeSH Terms

Comorbidity
Dataset
Diagnosis-Related Groups
Hospitals, General
Korea*
Medicaid
Medicare
National Health Programs
Patient Readmission
Quality Indicators, Health Care
Tertiary Care Centers
United States