Background: Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital’s control, may not accurately reflect a hospital’s performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA.
Methods: We calculated 2 sets of risk-adjusted readmission rates by (1) using the Centers for Medicare & Medicaid Services standard risk-adjustment algorithm that incorporates patient age, sex, comorbidities, and hospital effects and (2) adding race/ethnicity and socioeconomic status to the model. Using data from the Healthcare Cost and Utilization Project, 2011 State Inpatient Databases, we compared the relative performances of 1,194 hospitals across the 2 methods.
Results: Addition of race/ethnicity and socioeconomic status to the risk-adjustment algorithm resulted in (1) little or no change in the risk-adjusted readmission rates at nearly all hospitals; (2) no change in the designation of the readmission rate as better, worse, or not different from the population mean at >99% of the hospitals; and (3) no change in the excess readmission ratio at >97% of the hospitals.
Conclusions: Inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at <3% of the hospitals. We believe that policymakers and payers should consider this result when deciding whether to include race/ethnicity and socioeconomic status in risk-adjusted THA and TKA readmission rates used for hospital accountability, payment, and public reporting.
Level of Evidence: Prognostic Level III. See instructions for Authors for a complete description of levels of evidence.
Investigation performed at Truven Health Analytics, Inc., Santa Barbara, California
Disclosure: This work was supported by the Agency for Healthcare Research and Quality (AHRQ) Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP) under contract HHSA-290-2013-00002-C. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect those of the AHRQ or the U.S. Department of Health and Human Services.
- Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated
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