What metrics are used to measure the success of a readmission reduction program?

1 Readmission rate

The most obvious metric to track is the readmission rate, which is the percentage of patients who are readmitted to the hospital within a certain time frame after discharge. The time frame can vary depending on the condition, the payer, and the benchmark. For example, Medicare uses 30 days as the standard for most conditions, and penalizes hospitals that have higher than expected readmission rates for certain diagnoses. However, some conditions may require shorter or longer time frames, such as 7 days for heart failure or 90 days for hip replacement. The readmission rate can help you identify areas of improvement, compare your performance with peers, and estimate the potential savings or penalties from reducing readmissions.

3 Readmission index

A third metric that can be helpful is the readmission index, which is the ratio of readmissions to total admissions. The readmission index can help you assess the overall burden of readmissions on your hospital, and how it affects your capacity, resources, and revenue. A high readmission index means that a large proportion of your admissions are readmissions, which may indicate poor quality of care, inadequate discharge planning, or lack of coordination with post-acute care providers. A low readmission index means that a small proportion of your admissions are readmissions, which may indicate effective care management, patient education, and follow-up. The readmission index can also help you identify the sources and patterns of readmissions, such as the most common diagnoses, time intervals, and facilities.

4 Patient-reported outcomes

A fourth metric that can be valuable is the patient-reported outcomes, which are the measures of patients' health status, satisfaction, and quality of life after receiving care. Patient-reported outcomes can help you capture the patient's perspective and experience of care, and how it affects their functional ability, symptom relief, and well-being. Patient-reported outcomes can also help you evaluate the effectiveness and value of your interventions and strategies, and how they align with the patient's goals and preferences. Some examples of patient-reported outcomes are the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the Patient-Reported Outcomes Measurement Information System (PROMIS), and the Patient Health Questionnaire (PHQ-9).

5 Process and structure measures

A fifth metric that can be useful is the process and structure measures, which are the measures of the activities and resources that are involved in delivering care. Process and structure measures can help you monitor and improve the quality and efficiency of your care delivery, and how it affects the outcomes of care. Process measures can include indicators such as medication reconciliation, discharge instructions, follow-up appointments, and transitional care management. Structure measures can include indicators such as staffing ratios, bed availability, electronic health records, and care coordination programs. Process and structure measures can help you identify the gaps and barriers in your care processes and structures, and implement best practices and evidence-based guidelines to reduce readmissions.

6 Cost and utilization measures

A sixth metric that can be helpful is the cost and utilization measures, which are the measures of the resources and expenses that are associated with providing care. Cost and utilization measures can help you analyze and optimize the financial performance and sustainability of your readmission reduction program, and how it affects your bottom line. Cost measures can include indicators such as average length of stay, average cost per case, and total cost of care. Utilization measures can include indicators such as bed days, emergency department visits, and outpatient services. Cost and utilization measures can help you identify the drivers and opportunities of cost and utilization reduction, and implement strategies to enhance value and efficiency.