HLM: Are readmissions a valid quality metric?
Yeh: If readmissions correlated precisely 100% with mortality, then we would not need it as a metric, because we have mortality as a metric.
The fact that those are not correlated does not mean to me that readmissions are not a useful metric. It is true that there are many readmissions that are for reasons that probably have very little to do with hospital quality. It's a blunt instrument, no doubt.
As clinicians in hospitals, we can't say, 'we're doing everything right and there is no waste in the system.' There are preventable readmissions. We know that.
Readmission rates should not be zero, but the fraction of those readmissions that are preventable with better communication and care redesign should be prevented and that's what these readmissions measures are trying to target.
HLM: What can be tweaked to make readmissions a more effective measure?
Yeh: The main question is what are the actual interventions that are reducing readmissions? One of the challenges when we use administrative claims data is that they lack granularity; precise reasons for why patients get readmitted.
If you don't know the precise reasons for readmissions, it's hard to design rational approaches to prevent them. You need to go into your own health system and get detailed electronic medical record data or chart review and understand who are these patients who are coming back, not at the 1,000-foot level like we have done here, but on the individual patient level and understand what are the things that may have prevented that individual patient from getting readmitted.
It's not sexy, splashy research, but when we aggregate and understand those reasons we can design appropriate interventions.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.