{'fraction_non_alphanumeric': 0.02161587526576896, 'fraction_numerical': 0.0031892274982282067, 'mean_word_length': 5.8024096385542165, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Associations between hospital-wide readmission rates and mortality measures at the hospital level: Are hospital-wide readmissions a measure of quality?

The Centers for Medicare & Medicaid Services (CMS) have sought to reduce readmissions in the 30 days following hospital discharge through penalties applied to hospitals with readmission rates that are higher than expected. Expected readmission rates for Medicare fee-for-service beneficiaries are calculated from models that use patientlevel administrative data to account for patient morbidities. Readmitted patients are defined as those who are discharged from the hospital alive and then rehospitalized at any acute care facility within 30 days of discharge. These models explicitly exclude sociodemographic variables that may impact quality of and access to outpatient care. Specific exclusions are also applied based on diagnosis codes so as to avoid penalizing hospitals for rehospitalizations that are likely to have been planned. More recently, a hospital-wide readmission measure has been developed, which seeks to provide a comprehensive view of each hospital’s readmission rate by including the vast majority of Medicare patients. Like the conditionspecific readmission measures, the hospital-wide readmission measure also excludes sociodemographic variables and incorporates specific condition-based exclusions so as to avoid counting planned rehospitalizations (e.g., an admission for cholecystectomy following an admission for biliary sepsis). Although not currently used for payfor-performance, this measure has been included in the CMS Star Report along with other readmission measures. CMS does not currently disseminate a hospitalwide mortality measure, but does disseminate hospitallevel adjusted 30-day mortality rates for Medicare beneficiaries with discharge diagnoses of stroke, heart failure, myocardial infarction (MI), chronic obstructive pulmonary disease (COPD) and pneumonia, and principal procedure of coronary artery bypass grafting (CABG). It is conceivable that aggressive efforts to reduce readmissions might delay life-saving acute care in some scenarios, and there is prior evidence that heart failure readmissions are inversely (but weakly) related to heart failure mortality. It is also plausible that keeping tenuous patients alive until discharge might result in higher readmission rates. We sought to examine the relationship between hospital-wide adjusted 30-day readmissions and death rates across the acute care hospitals in the United States. Lacking a measure of hospital-wide death rates, we examined the relation between hospital-wide readmissions and each of the 6 condition-specific mortality measures. For comparison, we also examined the relationships between condition-specific readmission rates and mortality rates.