Measuring Quality of Neurosurgical Care: Readmission Is Affected by Patient Factors

Objective The Hospital Readmission Reduction Program section of the Patient Protection and Affordable Care Act uses readmission rates as a proxy for measuring quality of care. Multiple studies have demonstrated that readmission rates are highly imprecise proxies for quality of care because readmission rates contain large amounts of statistical noise and are dependent on disease type, insurance type, severity, population, and a multitude of other factors. The current study was conducted to investigate characteristics associated with readmission and the quality of neurosurgical care. Methods Admissions data were gleaned from the University Health System Consortium database for neurosurgical patient (both cranial and spine) readmissions to assess patient-related factors relating to readmission from January 2011 to December 2014. Results Among 257,212 admissions for neurosurgical disease analyzed, patients with Medicaid and private payers as a primary insurance source had increased rates of readmission (odds ratio for readmission of 1.38 and 1.17, respectively) compared with patients with Medicare or other primary insurers. Patients with greater severity of disease and emergent or urgent admission also had statistically significant rates of readmission. Conclusions The findings suggest that readmission is affected by patient factors that are beyond the control of treating physicians. These findings also suggest that readmission rates may not be a good proxy for measurement of quality of care in neurosurgical patients.