Concept: Readmissions to Hospital

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Concept Description

Last Updated: 2001-10-01

Introduction
    There are many factors to consider when analyzing readmissions. For example:

    • What cases, if any, should be excluded prior to defining index cases? (e.g. non-inpatient hospitalizations)
    • Who is the cohort for whom readmissions are to be counted?
    • Which hospitalizations should be excluded from being counted as readmissions (e.g., transfers, concurrent stays, deaths, elective, extended care)?
    • How does one define such exclusions?
Approaches
    Different approaches have been adopted at MCHP depending on analysis needs:

    • Project-specific programs have been developed for MCHP researchers (see example below).
    • The COMBINE macro has been used to generate readmission information (e.g. for SBGH data).
    • A user-friendly graphical user interface has been developed. Some work has been done on this approach by Charles Burchill.

    EXAMPLE: Readmissions were run for urban hospitals for 14 medical/surgical diagnoses for a range of 6 years (1989/90 -1994/95) of Hospital Discharge Abstracts data. The ADRG's were used to select these diagnoses:
    89 - Simple Pneumonia
    96 - Bronchitis and Asthma
    121 - AMI
    127 - Heart failure
    148 - Major Bowel
    157 - Anal / Stomal
    161 - Inguinal / Hernia
    182 - Digestive disorders
    197 - Open Cholecystectomy
    336 - Prostatectomy
    358 - Uterine / Adnexal
    370 - C section
    373 - Vaginal delivery
    430 - Psychoses
    493 - Lap. Cholecystectomy

    The readmission for any of the 14 diagnoses was defined as an inpatient admission to any hospital for any reason within 30 days from the index admission (from date of discharge). The index admission was restricted to:

    • Winnipeg Urban Hospitals
    • a LOS restriction of 30, 60 and 90 days depending on the diagnosis.
    • In another scenario First Nations, residents from the core area, and the high severity cases (using RDRG's®) were removed.

    Different index admission restrictions can be defined and re-programmed easily.

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References 

  • Brownell M, Roos NP, Burchill C. Monitoring the Winnipeg Hospital System: 1990/91 Through 1996/97. Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation, 1999. [Summary] [Full Report] (View)
  • Brownell M, Roos NP. Monitoring the Winnipeg Hospital System: The Update Report 1993/1994. Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation, 1996. [Summary] [Full Report] (View)
  • Harrison ML, Graff LA, Roos NP, Brownell MD. Discharging patients earlier from Winnipeg hospitals: does it adversely affect quality of care? CMAJ 1995;153(6):745-751. [Abstract] (View)
  • Roos LL, Cageorge SM, Roos NP, Danzinger R. Centralization, certification, and monitoring. Readmissions and complications after surgery. Med Care 1986;24(11):1044-1066. [Abstract] (View)
  • Roos NP, Shapiro E. Monitoring the Winnipeg Hospital System: The First Report. 1990-1992 . Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation, 1994. [Summary] [Full Report] (View)