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Abstract

Introduction: Readmission following hospital discharge is both common and costly. The HospitalReadmission Reduction Program (HRRP) financially penalizes hospitals for readmission followingadmission for some conditions, but this approach may not be appropriate for all conditions. We wished todetermine if hospitals differed in their adjusted readmission rates following an index hospital admissionfor traumatic injury.Patients and Methods: We extracted from the AHRQ National Readmission Dataset (NRD) all non-elderlyadult patients hospitalized following traumatic injury in 2014. We estimated hierarchal logisticregression models to predicted readmission within 30 days. Models included either patient levelpredictors, hospital level predictors, or both. We quantified the extent of hospital variability inreadmissions using the median odds ratio. Additionally, we computed hospital specific risk-adjustedrates of readmission and number of excess readmissions.Results: Of the 177,322 patients admitted for traumatic injury 11,940 (6.7%) were readmitted within 30days. Unadjusted hospital readmission rates for the 637 hospitals in our study varied from 0% to 20%.After controlling for sources of variability the range for hospital readmission rates was between 5.5% and8.5%. Only 2% of hospitals had a random intercept coefficient significantly different from zero, suggestingthat their readmission rates differed from the mean level of all hospitals. We also estimated that in 2014only 11% of hospitals had more than 2 excess readmissions. Our multilevel model discriminated patientswho were readmitted from those not readmitted at an acceptable level (C = 0.74).Conclusions: We found little evidence that hospitals differ in their readmission rates following an indexadmission for traumatic injury. There is little justification for penalizing hospitals based on readmissionsafter traumatic injury.

Item Type:	Article
Authors/Creators:	Osler, T and Yuan, D and Holden, J and Huang, Z and Cook, A and Glance, LG and Buzas, JS and Hosmer, DW
Keywords:	statistical models for survival, trauma, readmission, hospital performance, outcomes
Journal or Publication Title:	Injury
Publisher:	Elsevier Sci Ltd
ISSN:	0020-1383
DOI / ID Number:	https://doi.org/10.1016/j.injury.2018.08.021
Copyright Information:	© 2018 Elsevier Ltd. All rights reserved.
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