NQF endorses all-cause unplanned readmissions measures
The National Quality Forum (NQF) board of directors has endorsed two measures that address all-cause unplanned readmissions in hospitals – an area of healthcare targeted for improvement given national imperatives to make healthcare safer, more affordable and keep people healthy.
"Almost one in five Medicare beneficiaries that leave a hospital end up being readmitted within 30 days," said Janet Corrigan, PhD, president and CEO of NQF in a press release. "Those readmissions cost about $15 billion annually, and many have the potential to be prevented. These new measures help push us as a nation to address this serious problem."
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Research shows an avoidable hospital readmission can mean prolonged illness, emotional distress and loss of productivity. Readmissions are attributable to a wide range of factors, including the availability of social supports and post-acute care for people, especially those of low income, as they transition from the hospital back into the community.
The first measure endorsed, developed by the National Committee for Quality Assurance (NCQA), counts the number of inpatient stays for patients aged 18 and older during a measurement year that were followed by an acute readmission for any diagnosis to any hospital within 30 days. It contrasts this count with a calculation of the predicted probability of an acute readmission. NCQA's measure is intended for quality monitoring and accountability at the health plan level.
The second measure, co-developed by the Centers for Medicare & Medicaid Services (CMS) and researchers at Yale University, estimates the risk-standardized rate of unplanned, all-cause readmissions to a hospital for any eligible condition within 30 days of hospital discharge for patients aged 18 and older. The measure will result in a single summary risk-adjusted readmission rate for conditions or procedures that fall under five specialties: surgery/gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology. The CMS/Yale measure is specified for evaluating hospital performance.
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NQF worked with both measure developers to assure that the two measures will be harmonized to ensure that the measures assess readmissions in a similar manner. For example, both measures will be aligned to remove the same set of planned readmissions.
In endorsing the CMS/Yale measure, the NQF Board offered the following guidance to accompany the measure and help explain the multifaceted nature of hospital readmissions and the opportunity for broad stakeholder collaboration to help address the issue:
"Multiple factors affect readmission rates and other measures including: the complexity of the medical condition and associated therapies; effectiveness of inpatient treatment and care transitions; patient understanding of and adherence to treatment plans; patient health literacy and language barriers; and the availability and quality of post-acute and community-based services, particularly for patients with low income. Readmission measurement should reinforce national efforts to focus all stakeholders' attention and collaboration on this important issue."
