Concept: Readmissions to Hospital
Last Updated: 2001-10-01
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?
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.
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.
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:
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:
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
Different index admission restrictions can be defined and re-programmed easily.
- Duplicate Records - Hospital Discharge Abstracts
- Episodes of Care
- Health Status Indicators - Recommended for Monitoring Regional Health Authority (RHA) Performance and Planning Delivery of Service
- 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. [Report] [Summary] (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. [Report] [Summary] (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. [Report] [Summary] (View)
Manitoba Centre for Health Policy
Community Health Sciences, Max Rady College of Medicine,
Rady Faculty of Health Sciences,
Room 408-727 McDermot Ave.
University of Manitoba
Winnipeg, MB R3E 3P5 Canada