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Stroke Readmission and Mortality Measures Overview

Dry Run of the Stroke Readmission and Mortality Measures

The Centers for Medicare & Medicaid Services (CMS) is introducing the stroke 30-day risk-standardized readmission and mortality measures for non-federal acute care hospitals and critical access hospitals in the 2013 Dry Run. The stroke readmission measure assesses hospital-level unplanned readmission rate within 30 days of discharge for patients hospitalized with an acute ischemic stroke. The stroke mortality measure assesses hospital-level mortality rate within 30 days of admission for patients hospitalized with an acute ischemic stroke. Measuring and reporting stroke readmission and mortality rates will inform health care providers about opportunities to improve care, strengthen incentives for quality improvement, and promote improvements in the quality of care received by patients and in the outcomes they experience.

The measures, which CMS has adopted for the Inpatient Quality Reporting (IQR) program in the FY 2014 Inpatient Prospective Payment System (IPPS) final rule, will expand the outcomes measures used in the Claims-Based Measures program. CMS currently reports similar risk-standardized 30-day readmission and mortality measures for Medicare Fee-for-Service (FFS) patients hospitalized for acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and total hip and knee arthroplasty (THA/TKA) complication and readmission on the CMS Hospital Compare website.

The dry run of the stroke readmission and mortality measures is consistent with the priorities of the Department of Health and Human Services' National Quality Strategy, which aims to: a) improve health care quality; b) improve the health of the U.S. population; and c) reduce the costs of health care.

For more information about the stroke readmission and mortality measures, refer to the Measure Methodology and Resources pages.

Note: Hospitals will receive their 2013 Hospital-Specific Reports (HSRs) beginning August 12, 2013. CMS proposed in the FY 2014 IPPS rule to report the stroke measure results publicly in 2014.

Background

30-day readmissions to an acute care facility and 30-day mortality following an acute care episode are outcome measures of care that can provide a more comprehensive view of quality that extends beyond what is captured by any one process of care measure. Complex and important aspects of care, such as coordination among providers, transitions from one setting of care to another, provider prevention of and response to complications all contribute to patient outcomes but are difficult to assess with process of care measures.

The readmission and mortality measures are complementary measures. The readmission measures will encourage quality improvement efforts targeted toward improving inpatient care and the transition to outpatient settings to minimize unplanned readmissions. The mortality measures encourage quality improvement efforts that aim to reduce mortality from all causes for hospitalized patients.

These measures were developed, under contract, by a team of clinical and statistical experts from Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE). They are based on administrative Medicare claims data and adjust for each hospital's case mix (patient age, gender, and comorbidities), so that hospitals that care for older, sicker patients are on a “level playing field” with hospitals serving healthier patients.

National Provider Call

CMS will hold a national provider call for the stroke measures during the dry run, on August 20 (3:00 – 4:30 pm ET). Hospitals, Quality Improvement Organizations (QIOs), and other stakeholders are invited to participate during the call. For more information about the call and a link for call registration, refer to the National Provider Calls page.

Questions and Comments

YNHHSC/CORE is supporting CMS in the dry run of these measures. Send questions about the stroke readmission measure to YNHHSC/CORE at strokereadmission@yale.edu and questions about the mortality measures to strokemortality@yale.edu. To ensure proper handling of inquiries, please reference the specific measure(s) and the specific program(s) to which your questions relate. Do NOT submit patient-identifiable information (e.g., Date of Birth, Social Security Number, Health Insurance Claim Number) to these addresses.

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