Becker's Clinical Quality & Infection Control

17 QUALITY IMPROVEMENT & MEASUREMENT Why this tool to predict readmission risk may have a blind spot By Megan Knowles T he "LACE index," a tool physicians and nurses oen use to determine hospital patients' readmission risk, may have a blind spot, according to research from Morgantown-based West Virginia University. LACE stands for length of stay, acuity, comorbidity and emergency department (the four readmission risk factors the index considers). Patients who score higher in these four areas usually have an increased readmission risk. But the researchers found the LACE index does not consider a key variable that may improve its predictions: whether patients are on Medicaid. "LACE was validated and tested in Ontario, Can- ada," said researcher Jennifer Mallow, PhD, MSN. "e LACE index didn't look at things like payer because they have universal healthcare." To evaluate the index's predictive value, the researchers compared patients' 30-day re- admission rates to their LACE index scores, insurance status and functional issues such as illiteracy and substance misuse. e only LACE variable that was linked to increased readmission rates was comorbidity, and the correlation was not very strong, the researchers found. Additionally, LACE scores were typically high- er for patients who did not return to the hospi- tal, even though its design says the opposite. e researchers found payer type had a significant relationship to readmission rates, and determining whether patients are on Medicaid could help providers better predict their readmission risk. Including insurance status in the LACE in- dex or more reliable measures of health dis- parities may help providers determine which patients have the highest risk of readmission, the researchers said. n Hospital readmission improvements under Medicare program may be overstated By Morgan Haefner S uccess from the Hospital Readmissions Reduction Program, which penalizes hospitals with high 30-day readmission rates among Medicare beneficiaries, may be overstated, according to a study published in Health Affairs. Five study findings: 1. While prior studies have credited the HRRP with lowering risk-adjusted readmission rates for conditions like acute myocardial infarction, heart failure and pneumonia, a concurrent change in how hospitals document diagnoses may have caused those results to be "illusory or overstated," according to the study. 2. The change, which affected the electronic transaction standards, allowed hospitals to include more diagnoses per claim. As a result, risk-adjusted patient readmission rates fell. 3. Previous studies concerning HRRP were based on control groups with lower baseline readmission rates, which the authors said "could falsely create the appearance that readmission rates are changing more in the treatment than in the control group." 4. When the researchers included the revised standards, they saw a 48 per- cent decline in risk-adjusted readmission rates for targeted conditions. 5. "After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples," the authors wrote. "Either the HRRP had no effect on readmissions, or it led to a systemwide reduction in readmissions that was roughly half as large as prior estimates have suggested." n Hospital insurance claims probably not best way to track SSIs, study suggests By Megan Knowles H ospital claims data may not be adequate to track surgical site infections, a study published in Infection Control & Hospital Epidemiology found. The researchers compared data from the CDC's National Healthcare Safety Network database to hospital insurance claims data for infections after colon surgery as reported by 155 hospitals. The study revealed significant discrepancies between the two data sourc- es, particularly among hospitals in the South and those that care for more Medicaid patients, and highlighted the CDC database's importance for determining hospital quality. A single, agreed-upon national set of definitions and data is of greater importance for public reporting and value-based payment programs than hospital claims data, the researchers concluded. n

• Cover