Readmissions Measures: Process & Outcome

Barbara Brown, RN, PhDVice President

Virginia Hospital & Healthcare Association

Medication Reconciliation:Medication Reconciliation:•Percent of patients, regardless of age, discharged from an inpatient facility to home or any other site of care who received a reconciled medication list at the time of discharge.

o Numerator: Number of patients, regardless of age, discharged from an inpatient facility to home or any other site of care who received a reconciled medication list at the time of discharge.

o Denominator: Total number of patients discharged per month

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Readmission Process Measure

• Medication Reconciliation Definition (based upon Medication Reconciliation Definition (based upon NQF-endorsed measure #646)NQF-endorsed measure #646)o Reconciled at discharge is defined as having a

reconciled list of a) medications to be taken by patient (continued and new), b) prescribed dosage, instructions and intended duration for each continued and new, and c) medications not to be taken by patient (discontinued and due to allergies and adverse reactions).

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Readmission Process Measure

o Sample: Random sample of 10 charts or 10% of discharges, whichever is greater, hospital-wide or unit-wide.

o Frequency: Monthly

o Submission: Quarterly enter data in NC secure QDS website within 20 days of close of quarter.

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Readmission Process Measure

Month Data Collected Date Due into QDS

May & June July 20, 2012

July, August & September October 20, 2012

October, November & December January 20, 2012

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Readmission Process Measure

Enter the numerator and denominator in the QDS websitehttps://data.ncqualitycenter.org/

• Outcome Measure 1: All Cause, all payer, all Outcome Measure 1: All Cause, all payer, all condition 30 day readmission ratecondition 30 day readmission rateo Numerator: Number of patients readmitted to the

index hospital or another hospital within 30 days of discharge

o Denominator: Number of patients discharged to home or other site of care for the same time period.

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Readmissions Outcome Measures:

• Outcome Measure 2Outcome Measure 2: % of patients with myocardial : % of patients with myocardial infarction readmitted to hospital within 30 days of infarction readmitted to hospital within 30 days of discharge.discharge.

• Outcome Measure 3Outcome Measure 3: % of patients with heart failure : % of patients with heart failure readmitted to hospital within 30 days of dischargereadmitted to hospital within 30 days of discharge

• Outcome Measure 4Outcome Measure 4: % of patients with pneumonia : % of patients with pneumonia readmitted to hospital within 30 days of dischargereadmitted to hospital within 30 days of discharge

• Outcome Measure 5Outcome Measure 5: Observed and Risk-adjusted 30-: Observed and Risk-adjusted 30-Day All-Cause Readmission RatesDay All-Cause Readmission Rates

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Readmissions Outcome Measures:

• Outcome Measures Submission: Outcome Measures Submission: o No submission required by hospital. All outcome

measures will be calculated using the inpatient patient level database and will be submitted quarterly. The observed/expected readmission rate will be calculated using the United Health Group methodology accepted by the National Quality Forum. The readmission rates for diabetes, heart failure and myocardial infarction will mirror CMS methodology.

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Readmissions Outcome Measures: