Readmission Methodology - Reason for Readmission (Planned vs. Unplanned) - Non Risk-Adjusted

This methodology applies to the Facility Reason for Readmission (Planned vs. Unplanned) Analysis.

1. Define the number of days used to calculate the readmission rate (at the Readmission Days required prompt).
2. Identify readmitted cases stratified by diagnoses or other selected characteristics.

Overview

• Interval: You define the interval at the Readmission Days prompt (0–365 days can be selected). 30 days is the default.
• All-Cause: Readmissions are for patients readmitted with any diagnosis.
• Patient Type: Only acute inpatients (Patient Type 08).
• Readmission Rate: This analysis is based on PRA v4.0 and includes the values for Readmission Rate, Unplanned Readmission Rate, and Planned Readmission Rate.

• Same-Day Readmissions: Same-day readmissions are considered planned and included in the planned readmissions.
• Risk Method: This analysis is not risk-adjusted.

Readmission Rate

The readmission rate calculation is as follows:

Numerator Readmitted cases to the same facility for a selected population*
Denominator Total cases included in a selected population. Each denominator case can have only one readmission

*The numerator includes same-day readmissions, since they are considered planned readmissions.

Unplanned Readmission Rate

The Unplanned Readmission Rate calculation is as follows:

Numerator Unplanned Readmitted cases to the same facility for a selected population
Denominator Total cases included in a selected population. Each denominator case can have only one readmission

Planned Readmission Rate

The Planned Readmission Rate calculation is as follows:

Numerator Planned Readmitted cases to the same facility for a selected population*
Denominator Total cases included in a selected population.

*The numerator includes same-day readmissions, since they are considered planned readmissions.

Note: The Planned Readmission Rate excludes patients that do not qualify for the All-Cause Hospital Wide 30-Day Readmission (PRA v4.0) cohort

Denominator Exclusions

The following patients are excluded from the denominator:

Code	Description
02	Discharged/Transferred to Other Facility
05	Discharged/Transferred to Cancer Center or Children's Hospital
07	Left Against Medical Advice or Discontinued Care
20	Expired
40	Expired at Home (For Medicare and Tricare claims for Hospice)
41	Expired in Medical Facility
42	Expired, Place Unknown (For Hospice)
43	Discharged/Transferred to Federal Hospital
66	Discharged/Transferred to a Critical Access Hospital (CAH)
82	Discharged/Transferred to a short term general hospital for inpatient care with a planned acute care hospital inpatient readmission (effective 10/1/2013 discharges)
85	Discharged/Transferred to a Designated Cancer Center or Children's Hospital with a planned acute care hospital inpatient readmission (effective 10/1/2013 discharges)
88	Discharged/Transferred to a federal health care facility with a planned acute care hospital inpatient readmission (effective 10/1/2013 discharges)
94	Discharged/Transferred to a Critical Access Hospital (CAH) with a planned acute care hospital inpatient readmission (effective 10/1/2013 discharges)

Readmission Days Prompt

In the Readmission Days prompt on the Select Population tab, you define the readmission interval, which identifies the readmitted cases to include in the analysis. “30 Days” is entered by default.

The system looks forward from the Discharge Date for each patient included in the denominator and identifies each readmitted case that is less than or equal to the Readmission Days selected. The system identifies readmitted cases beyond the selected population’s timeframe up to the Readmission Days selected.

Population Selection and Patient Types

All prompt selections, except Patient Type, determine the population for which the system will report readmissions (numerator cases).

This analysis considers only acute inpatients (Patient Type 08).