Impact on hospital ranking of basing readmission measures on a composite endpoint of death or readmission versus readmissions alone

Table 3 Hospital Performance based on the Composite Outcome versus Readmission Performance Metric

	Readmission or death
	High-performance	Average-performance	Low-performance
	AMI, CHF, or PNEU			Hospital AOR, median (range)	Kappa
Readmission, No. (%)					0.54
High-performance	12 (80.0)	3 (20.0)	0 (0)	0.81 (0.69-0.90)
Average-performance	23 (14.0)	130 (79.3)	11 (6.7)	0.99 (0.81-1.17)
Low-performance	0 (0)	5 (20.8)	19 (79.2)	1.24 (1.13-1.43)
Hospital AOR, median (range)	0.79 (0.48-0.92)	0.99 (0.63-1.46)	1.33 (1.16-1.66)
	Acute Myocardial Infarction				0.13
Readmission, No. (%)
High-performance	2 (100)	0 (0)	0 (0)	0.76 (0.70-0.81)
Average-performance	16 (8.7)	164 (88.7)	5 (2.7)	1.00 (0.81-1.26)
Low-performance	0 (0)	1 (100)	0 (0)	1.23 (NA)
Hospital AOR, median (range)	0.80 (0.59-0.88)	1.02 (0.78-1.35)	1.41 (1.23-1.44)
	Congestive Heart Failure				0.53
Readmission, No. (%)
High-performance	8 (88.9)	2 (11.1)	0 (0)	0.80 (0.73-0.88)
Average-performance	10 (5.6)	158 (88.3)	11 (6.15)	1.00 (0.83-1.23)
Low-performance	0 (0)	3 (27.3)	8 (72.7)	1.29 (1.13-1.37)
Hospital AOR, median (range)	0.77 (0.51-0.86)	0.98 (0.70-1.39)	1.33 (1.16-1.51)
	Pneumoniae				0.45
Readmission, No. (%)
High-performance	4 (66.7)	2 (33.3)	0 (0)	0.77 (0.74-0.81)
Average-performance	7 (3.7)	168 (88.9)	14 (7.4)	0.99 (0.83-1.31)
Low-performance	0 (0)	1 (12.5)	7 (87.5)	1.27 (1.21-1.44)
Hospital AOR, median (range)	0.76 (0.57-0.81)	0.99 (0.76-1.44)	1.34 (1.16-1.48)

NA not applicable, No number, AOR adjusted odds ratio, AMI acute myocardial infarction, CHF congestive heart failure, PNEU pneumonia
kappa – weighted kappa analysis

ISSN: 1472-6963