The correlation between racial disparities and overall quality is strong with a positive, statistically significant association for heart failure (0.87*, P < 0.05) and pneumonia (r = 0.67*, P < 0.05) readmission, indicating that hospitals that have high racial disparities tend to have worse hospital quality in terms of their overall RSRR
. For AMI readmission, the relationship is negative and statistically significant, but the strength of the association is weak (r =-0.22*, P< 0.05).
The Centers for Medicare & Medicaid Services publicly reports risk-standardized 30-day readmission rates (RSRRs) for patients with AMI, HF, and PN; these rates are risk-standardized using models that adjust for risk factors, including age, comorbidities, and prior history (Keenan et al.
By comparing [[sigma].sub.v.sup.2] to the total variation in RSRRs, [[sigma].sub.v.sup.2] + 1, we are able to assess how much of the national variation in the outcome is attributable to the county, and how much to the hospital.
Worse-than-expected: hospital's lower risk-standardized readmission rate (RSRR) confidence interval (CI) greater than the national observed rate.
We classified hospitals as having risk-standardized readmission rates (RSRRs) that were "worse-than-expected," "as-expected," or "better-than-expected" in accordance with the methodology used in VA and CMS Hospital Compare.
The VA now publicly reports hospital RSRRs for veterans age 65 and older on VA Hospital Compare, and these are calculated using index hospitalizations, readmissions, and risk factors obtained from VA-only data.
Hospitals with truly "good" RSRRs may be unfairly penalized, low performing hospitals may escape penalties, and confidence in readmission rates as a quality measure could decline.
The RSRRs were computed by taking the ERR and multiplying by the national readmission rate.
The HRM approach adjusts readmission rates of small hospitals so that their RSRRs tend to be closer to the national average than their actual observed rates.
However, it is unclear how additional adjustment for these factors affects the reliability of RSRRs. The reliability of measures often declines when adding variables in risk adjustment, because the added factors account for more of the between-hospital variation in RSRRs previously assumed to be differences in quality.
We compared the reliability of hospital RSRRs to a commonly used benchmark for group-level comparisons (Scholle et al.
Excess readmissions, which form the numerator of this calculation, are determined using the RSRRs, and if the RSRRs are unreliable, this could be the result in the penalty rates being influenced by statistical noise rather than hospital differences in quality of care.