Becker's Clinical Quality & Infection Control

60 QUALITY IMPROVEMENT & MEASUREMENT 30-day readmission rates not 'final word' on hospital quality, study suggests By Brian Zimmerman H ospital readmission rates reported by CMS for patients with certain condi- tions may not accurately reflect the actual quality of care delivered at hospitals, according to a study published in Annals of Internal Medicine. CMS' excess readmission ratios — which comprise data on readmissions for heart failure, heart attack and pneumonia — are used to determine Medicare reimbursement. To determine whether these ratios accurately reflect the quality of care delivered to all hospital patients, researchers analyzed ERRs across three patient groups. Researchers used more than 2,100 hospital observations documented in a nationwide readmissions database from 2013-14 to compare the ERRs of Medicare beneficiaries admitted for heart failure, heart attack or pneumonia; patients covered by non-Medicare payers; and Medi- care beneficiaries admitted for conditions not including heart failure, heart attack or pneumonia. Analysis revealed 29 percent of hospitals currently penalized by CMS would no longer incur penalties if the agency included read- missions related to conditions other than heart failure, heart attack or pneumonia. Re- searchers also found 40 percent of hospitals penalized by CMS would not face penalties if performance assessment was based on readmission rates for non-Medicare patients hospitalized for heart failure, pneumonia or heart attack. "Significant attention has been given to hospitals' overall performance as determined by the public reporting of a small number of specific conditions and patient populations," said Robert Yeh, MD, associate professor of medicine at Harvard Medical School in Boston and one of the study's authors. "Our results suggest that although performance on readmission may reflect broader institutional characteristics, the concordance of each hos- pital's performance across different condi- tions varies substantially. It goes to show that Medicare metrics alone may not be the final word on hospital quality for readmissions." n How lay-health workers are reducing readmission rates at a rural Kentucky hospital By Megan Knowles F or rural hospitals, lay-health workers, or those who perform healthcare functions but have not received formal professional education, can help reduce readmission rates, according to a study published in Health Education Research. The study examined how a lay-health worker program could help patients who had a high risk of readmission after they were dis- charged from the hospital. The program aims to assist these high- risk patients with their social needs. To determine how lay-health workers affected hospital readmission rates, the researchers looked at 30-day readmissions at a rural Ken- tucky hospital. Here are three study findings. 1. For patients who were in the lay-health worker program, the study found a nearly 48 percent reduction of 30-day hospital readmissions rates compared to the patients who were not a part of the program. 2. Additionally, the study found a 56 percent decrease in odds of being readmitted within 30 days among patients in the lay-health worker program compared with those not in the program. 3. After the researchers adjusted for patients' education, transporta- tion cost and anxiety symptoms, they found a 77 percent decrease in odds of being readmitted among patients who participated in the lay-health worker program. n Order of OR procedures could affect surgical performance By Anuja Vaidya A study published in the British Journal of Surgery examined the relationship between case list order and opera- tive performance. Researchers gathered operating room lists that included the 35 most frequently per- formed procedures by senior surgeons over 26 months in the U.K. The procedures spanned 38 private hospitals. They created a linear mixed effects mod- el that included 255,757 procedures and performed matched analysis of 48,632 pairs of procedures. The study shows switching between pro- cedures increased the operating duration by an average of 6.48 percent. The overall reduction in operating time from completing the second procedure straight after the first was 6.18 percent. "This pattern of results was consistent across procedure method and complexity," study authors noted. n

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