Does risk-adjusted readmission rate provide valid information on hospital quality?

The purpose of this study was to determine whether readmission rates, adjusted to account for differences in clinical characteristics of patients treated, provide valid information on hospital quality of care. Twelve clinical conditions were selected. Condition-specific models to predict readmission risk were estimated using Medicare UB-82 claims data. These models then were used to calculate readmission risk probabilities for patients whose medical records had been reviewed for quality of care by a Medicare peer review organization. I hypothesized that patients who received poor quality care during a hospitalization episode would be more likely to be readmitted after discharge than those who received acceptable quality care. My analysis found no support for this hypothesis. In each of the 12 clinical conditions studied, readmission rates of cases that received poor quality care were essentially the same as those whose care was judged acceptable. This was true both for readmission rates that were adjusted for patients' demographic and clinical characteristics, and for unadjusted rates, such as those typically displayed in hospital report cards.