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Variation in readmission rates among hospitals following admission for traumatic injury


Osler, T and Yuan, D and Holden, J and Huang, Z and Cook, A and Glance, LG and Buzas, JS and Hosmer, DW, Variation in readmission rates among hospitals following admission for traumatic injury, Injury, 50, (1) pp. 173-177. ISSN 0020-1383 (2019) [Refereed Article]

Copyright Statement

2018 Elsevier Ltd. All rights reserved.

DOI: doi:10.1016/j.injury.2018.08.021


Introduction: Readmission following hospital discharge is both common and costly. The Hospital Readmission Reduction Program (HRRP) financially penalizes hospitals for readmission following admission for some conditions, but this approach may not be appropriate for all conditions. We wished to determine if hospitals differed in their adjusted readmission rates following an index hospital admission for traumatic injury.

Patients and Methods: We extracted from the AHRQ National Readmission Dataset (NRD) all non-elderly adult patients hospitalized following traumatic injury in 2014. We estimated hierarchal logistic regression models to predicted readmission within 30 days. Models included either patient level predictors, hospital level predictors, or both. We quantified the extent of hospital variability in readmissions using the median odds ratio. Additionally, we computed hospital specific risk-adjusted rates of readmission and number of excess readmissions.

Results: Of the 177,322 patients admitted for traumatic injury 11,940 (6.7%) were readmitted within 30 days. Unadjusted hospital readmission rates for the 637 hospitals in our study varied from 0% to 20%. After controlling for sources of variability the range for hospital readmission rates was between 5.5% and 8.5%. Only 2% of hospitals had a random intercept coefficient significantly different from zero, suggesting that their readmission rates differed from the mean level of all hospitals. We also estimated that in 2014 only 11% of hospitals had more than 2 excess readmissions. Our multilevel model discriminated patients who were readmitted from those not readmitted at an acceptable level (C = 0.74).

Conclusions: We found little evidence that hospitals differ in their readmission rates following an index admission for traumatic injury. There is little justification for penalizing hospitals based on readmissions after traumatic injury.

Item Details

Item Type:Refereed Article
Keywords:statistical models for survival, trauma, readmission, hospital performance, outcomes
Research Division:Mathematical Sciences
Research Group:Applied mathematics
Research Field:Biological mathematics
Objective Division:Expanding Knowledge
Objective Group:Expanding knowledge
Objective Field:Expanding knowledge in the mathematical sciences
UTAS Author:Hosmer, DW (Professor David Hosmer)
ID Code:138966
Year Published:2019
Web of Science® Times Cited:7
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-05-14
Last Modified:2020-07-22

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