Researchers Discover Hospital Readmission Rates Found in Administrative Databases May Not Accurately Reflect Surgical Complications
Embargo expired: 11/27/2012 10:00 AM EST
Source Newsroom: American Association of Neurological Surgeons (AANS)
Newswise — CHARLOTTESVILLE, Va. and ROLLING MEADOWS, Ill. (Nov. 27, 2012) — Hospital administrative databases, which are designed to provide general information on hospital stays and associated costs, are frequently used to find information that can lead to quality assessments of care or clinical research. Researchers at the University of California, San Francisco (UCSF) extracted data on hospital readmissions following spine surgery at their institution from an administrative database to assess the clinical relevance of the information and to define clinically relevant predictors of readmission. What they found were readmission numbers substantially larger than expected or appropriate. The researchers’ findings are reported in the article “Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets. Clinical article,” by Beejal Y. Amin, MD, and colleagues, published online today, ahead of print, in the Journal of Neurosurgery: Spine (http://thejns.org/doi/full/10.3171/2012.10.SPINE12559).
UCSF is a member of the UHC (University HealthSystem Consortium), an alliance of 116 academic medical centers and more than 270 affiliated hospitals that form the Quality and Accountability Study. The UHC houses a repository for data provided by member hospitals, which can be used for benchmarking and to improve patient care. Using this database the researchers identified 5,780 initial patient encounters with spine surgeons at UCSF. Among these cases there were 281 instances of readmission (hospital admission within 30 days after hospital discharge; 4.9 percent of cases). The researchers examined individual patient files to identify the specific reasons for the readmissions. They found that 69 readmissions (25 percent of the 281 readmissions) had nothing to do with complications of spine surgery. In 14 cases, the patient returned to the hospital to undergo surgery that had been rescheduled; in 39 cases, the second admission was for the second part of a staged surgery; and in the other 16 cases, the reason for readmission was unrelated to spine surgery. In all these cases the “readmissions” were necessary and unavoidable. The other 212 readmissions (75 percent) were related to complications of the initial spine surgery.
The researchers note that after exclusion of the 69 readmissions unrelated to complications, the costs of hospital readmissions dropped 29 percent, reflecting a cost variance exceeding $3 million.
The authors state their concerns that the all-cause data collected from administrative databases on hospital readmissions following spine surgery may not accurately represent how patients fare following spine surgery. The researchers believe that unfiltered administrative data in this instance may lead to misinterpretations of both the quality and costs of patient care. This in turn could lead third-party payers (such as Medicare) to deny payments for some hospital “readmissions” that are unavoidable.
Inclusion of spine surgeons in defining the clinical relevance of data is important, say the authors. According to one coauthor, Praveen Mummaneni, MD, FAANS, “Our findings identify the potential pitfalls in the calculation of readmission rates from administrative data sets. Benchmarking algorithms for defining hospitals’ readmission rates must take into account planned, staged surgery and eliminate unrelated reasons for readmission, which are not clinically preventable. With these adjustments in the calculation method, the readmission rate will be more clinically relevant. Current tools overestimate the clinically relevant readmission rate and cost, and spine surgeons’ input is vital to ensure the relevance of such databases.”
Amin BY, Tu T-H, Schairer WW, Na L, Takemoto S, Berven S, Deviren V, Ames C, Chou D, Mummaneni PV. Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets. Clinical article, Journal of Neurosurgery: Spine, published online November 27, 2012, ahead of print; DOI: 10.3171/2012.10.SPINE12559.
Disclosure: Dr. Berven is a consultant for Medtronic, DuPuy Spine and Globus Medical; he has an ownership stake in AccuLIF. Dr. Deviren is a consultant for Medtronic, NuVasive, Guidepoint and Stryker. Dr. Ames is a consultant for DePuy, Medtronic and Stryker; is employed by UCSF; holds a patent with Fish & Richardson, P.C.; owns stock in TranS1, Doctors Research Group, and Visualase; and receives royalties from Aesculap and Lanx. Dr. Mummaneni is a consultant for DePuy; and receives royalties from DePuy, Quality Medical Publishers and Thieme Publishers.
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The Journal of Neurosurgery: Spine is a monthly peer-reviewed journal focused on neurosurgical approaches to treatment of diseases and disorders of the spine. It contains a variety of articles, including descriptions of preclinical and clinical research as well as case reports and technical notes. The Journal of Neurosurgery: Spine is one of four monthly journals published by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons (www.AANS.org), an association dedicated to advancing the specialty of neurological surgery in order to promote the highest quality of patient care. The Journal of Neurosurgery: Spine appears in print and on the Internet (www.thejns.org).
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 8,200 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves. For more information, visit www.AANS.org.