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

1. 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

2. 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

3. 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

4. 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

5. 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)

6. 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

7. Healthcare Cost and Utilization Project (HCUP) THE LARGEST COLLECTION OF MULTI-YEAR, ALL-PAYER, ENCOUNTER-LEVEL: INPATIENT EMERGENCY DEPARTMENT AMBULATORY SURGERY HOSPITAL-BASED ADMINISTRATIVE DATA

8. WA VT MT ND ME NH MN SD OR ID WI MA NY WY MI RI NV IA PA IN OH CT NE UT IL NJ CO WV CA VA DE KS MO KY MD NC AR TN OK AZ NM SC GA MS AL LA TX FL HI AK AK HCUP Database Participation 2009 Data Year Non-participating Partners Providing Inpatient Data Only Partners Providing Inpatient & Ambulatory Surgery Data Partners Providing Inpatient & Emergency Department Data Partners Providing Inpatient, Ambulatory Surgery,& Emergency Department Data Key:

9. Current HCUP Partners ArizonaDepartment 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 HawaiiHealth Information Corporation IllinoisDepartment of Public Health Indiana Hospital & Health Association Iowa Hospital Association KansasHospital Association 9

10. Current HCUP Partners KentuckyCabinet for Health and Family Services Louisiana Department of Health and Hospitals Maine Health Data Organization Maryland Health Services Cost Review Commission Massachusetts Division of Health Care Finance and Policy Michigan Health & Hospital Association MinnesotaHospital Association Missouri Hospital Industry Data Institute NebraskaHospital Association Nevada Division of Health Care Financing and Policy, Department of Health and Human Services New Hampshire Department of Health & Human Services 10

11. 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 OhioHospital Association OklahomaHealth 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 DakotaAssociation of Health Care Organizations Tennessee Hospital Association 11

12. Current HCUP Partners TexasDepartment of State Health Services Utah Department of Health Vermont Association of Hospitals and Health Systems VirginiaHealth Information WashingtonState Department of Health West Virginia Health Care Authority Wisconsin Department of Health and Family Services Wyoming Hospital Association 12

13. SASD SID HCUP State Databases All inpatient hospital discharge data (including those admissions that started in the ED) from participating HCUP States Ambulatory surgery data (hospital based and some freestanding) from participating HCUP States Emergency department data (treat and release) from participating HCUP States SEDD

14. 2009 SID Readmissions: Hospitalizations for Same Patient 1 hospital admission 3 hospital admissions from 2 unique people in SID 2 hospital admissions Readmissions: Sequential hospital admissions for a (un)related reason, and usually within a specific time frame.

15. 2009 SID 2009 SEDD Revisits: Multiple visits for same patient across hospital settings 1 hospital admission + 2 ED visits 3 hospital admissions + 3 ED visits from 2 unique people 2 hospital admissions + 1 ED visit Revisits: Multiple health care encounters for a particular patient for related or unrelated conditions.

16. Encrypted Patient Identifier PNUM_R Person number (re-identified)   Unique Patient Number for Each Patient

17. 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.

18. SID SEDD SASD HCUP Databases Can Be Combined to Provide a More Complete Picture The HCUP Revisit Files allow researchers to study multiple patient visits to the acute care setting, regardless of whether the visit resulted in hospital admission