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Ben Harder @benharder
, 12 tweets, 8 min read Read on Twitter
Two noteworthy findings by Wang @rkwadhera @DLBHATTMD in @JAMACardio:
1) Hospitals in the @usnews top 50 have better mortality rates than other hospitals in AMI, CABG & HF. Better HCAHPS, too. Not too surprising, but certainly reassuring.
2) But...…

2) But those same top hospitals do no better than others on readmission.

Why? Well, we have to ask ourselves whether readmission is a valid indicator of quality. And if it is, is it valid in all patient cohorts, or only certain ones?
As Wang @rkwadhera @DLBHATTMD understatedly write:

“The observed discrepancy between readmissions and other performance measures raises concern that readmissions may not be an adequate metric of hospital care quality.”
They add: “This disconnect...highlights the ongoing uncertainty as to whether readmissions rates are an adequate surrogate for quality of care, particularly for cardiovascular conditions, such as HF.”
Indeed, we @usnews do not use readmission in our Heart Failure ratings. Why?
We’ve found that readmission correlates weakly, if at all, with quality* in medical conditions such as HF and COPD.

In surgical episodes, by contrast, we find readmission consistently correlates with quality*.

(*By “quality,” I mean...
*By “quality,” I mean the latent variable that determines the @usnews Procedures & Conditions ratings. See…, Tables 5, 7, 9, 13, 17, 19 & 21.

Unlike readmission, mortality correlates with quality in every cohort we @usnews have examined, whether medical or surgical.

With the exception of AAA repair, we haven’t yet investigated endovascular procedures using these methods. So I can’t shed light on, for example, PCI.
Those who attended my talk @USNHoT this month heard me discuss (my slide shown here) two candidate outcome measures we are investigating for use in the @usnews Cardiology & Heart Surgery rankings and other specialty rankings.

Neither candidate measure was readmission.

Regarding CABG readmission, it’s worth noting the measure specifications & risk adjustment we use differ from @CMSGov specs & adjustment. While our measure correlates with CABG quality, I’m not shocked @rkwadhera @DLBHATTMD found the CMS measure doesn’t correlate as expected.

I plan to speak more about @usnews’s use of outcome measures at the ACC Quality Summit #ACC19 in New Orleans on March 14 (4pm local).

Thank you @ACCinTouch @ACCCVQuality for inviting me to be part of an important panel.
I also look forward to addressing, in my May 21 lecture at @RadiologyACR, the selection of outcome metrics used by @usnews. Measure selection is really crucial & differentiates valid ratings from invalid.

(Thank you @RichDuszak for inviting me to speak.)

#RSNA2018 #RSNA18
But wait, there’s more!

“Admission to a top-ranked hospital for neurology or neurosurgery was associated with lower 30-day risk-standardized mortality but higher readmission after ischemic stroke.”

Again, nonsurgical care (mostly) & readmits=fishy.…
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