Advanced SearchSearch Tips
Readmission Rate: Experience in USA, Canada and UK
facebook(new window)  Pirnt(new window) E-mail(new window) Excel Download
  • Journal title : Quality Improvement in Health Care
  • Volume 22, Issue 1,  2016, pp.29-37
  • Publisher : The Korean Society of Quality Assurance in Health Care
  • DOI : 10.14371/QIH.2016.22.1.29
 Title & Authors
Readmission Rate: Experience in USA, Canada and UK
Lee, Sang-Ah; Ju, Yeong-Jun; Shin, Jae-Yong; Park, Eun-Cheol; Lee, Hoo-Yeon;
  PDF(new window)
Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.
Readmission rate;Quality indicator;Quality of health care;
 Cited by
Rath S, Heuer C, Alle W, Bach A, Bischoff B, Bonsanto M, et al. Integration of generic indicators for quality management in hospital information systems. Int J of medical informatics 1999;55(3):179-88. crossref(new window)

Centers for Medicare & Medicaid Services. ACO #8-Risk standardized all condition readmissions. U.S. 2015.

Mainz J, Krog BR, Bjornshave B, Bartels P. Nationwide Continuous Qquality Improvement Using Clinical Indicators: the Danish National Indicator Project. Int J for Quality in Health Care 2004;16(suppl.1):i45-50 crossref(new window)

Mainz J. Developing Evidence-Based Clinical Indicators: A State of The Art Methods Primer. Int J for Quality in Health Care 2003;15(suppl.1):i5-11. crossref(new window)

Kim MH, Kim HS, Hwang SH. Developing a Hospital-Wide All-Cause Risk-Standardized Readmission Measure Using Administrative Claims Data in Korea: Methodological Explorations and Implications. J of Health Policy and Management 2015;25(3):197-206. crossref(new window)

Horwitz L, Partovian C, Lin Z, Herrin J, Grady J, Conover M. Hospital-wide all-cause unplanned readmission measure: final technical report. Baltimore, MD:CMS, 2012.

Canadian Institute for Health Information. All-Cause Readmission to Acute Care and Return to the Emergency Department. Canada:CIHI, 2012.

Sg2 Healthcare Intelligence. Sg2 Service Kit: reducing 30-day emergency readmissions. Skokie, U.S.: Sg2 Healthcare Intelligence, 2011.

Barnett ML, Hsu J, McWilliams JM. Patient Characteristics and Differences in Hospital Readmission Rates. JAMA Internal Medicine. 2015;175(11):1803-12. crossref(new window)

Blunt I, Bardsley M, Grove A, Clarke A. Classifying Emergency 30-day Readmissions in England Using Routine Hospital Data 2004-2010: What is the Scope for Reduction? Emergency Medicine Journal 2014;0:1-7. doi:10.1136/emermed-2013-202531. crossref(new window)

Nolte E, Roland M, Guthrie S, Brereton L. Preventing emergency readmissions to hospital. EU. Rand Corporation. 2012.

Luthi J, Burnand B, McClellan W, Pitts S, Flanders W. Is Readmission to Hospital an Indicator of Poor Process of Care for Patients with Heart Failure? Quality and safety in Health care 2004;13(1):46-51. crossref(new window)

Kossovsky MP, Sarasin FP, Perneger TV, Chopard P, Sigaud P, Gaspoz J-M. Unplanned readmissions of patients with congestive heart failure: do they reflect in-hospital quality of care or patient characteristics? The American J of medicine 2000;109(5):386-90. crossref(new window)

Berenson RA, Paulus RA, Kalman NS. Medicare's Readmissions-Reduction Program-A Positive Alternative. New England J of Medicine 2012;366(15):1364-6. crossref(new window)

CMS. Readmissions Reduction Program(HRRP)[Internet]. U.S. [cited 2016 April 18]. Available from:

Horwitz L, Partovian C, Lin Z, Herrin J, Grady J, Conover M, et al. Hospital-Wide (All-Condition) 30-day Risk-Standardized Readmission Measure. DRAFT Measure Methodology Report. Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation:2011 Aug 10. Contract number: HHSM-500-2008-0025I/HHSM-500-T0001

Horwitz L, Grady J, Lin Z. Dorsey K, Zhang J, Keenan M, et al. Hospital-Wide All-Cause Unplanned Readmission (Version 3.0). 2014 Measure Updates and Specifications Report. ale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation: 2014 July.

Health UDo, Services H. New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings. Washington, U.S.: Department of Health and Human Services: 2014 May 7.

Boozary AS, Manchin J, Wicker RF. The Medicare Hospital Readmissions Reduction Program: Time for Reform. J of the American Medical Association 2015;314(4):347-8. crossref(new window)

Monette M. Hospital readmission rates under the microscope. Canadian Medical Association J 2012;184(12):E651-2. crossref(new window)

A Data Catalogue for NHS England. 3.2 Emergency readmissions within 30 days of discharge from hospital Health & Social Care Information Centre. HSCIC. 2010 [cited 2010 Mar 14]. Available from:

Clinical Indicators team Health and Social Care Information Centre. Hospital Episode Statistics, Emergency Readmissions to Hospital Within 28 Days of Discharge-Financial year 2011-12. England:HSCIC, 2013 Dec 5.

Greysen SR, Cenzer IS, Auerbach AD, Covinsky KE. Functional Impairment and Hospital Readmission in Medicare Seniors. JAMA internal medicine 2015;175(4):559-65. crossref(new window)

Kim J. Strategies to enhance the use of National Health Insurance claims database in generating health statistics. Seoul: HIRA. 2005.