Medical Care

Skip Navigation LinksHome > May 2013 - Volume 51 - Issue 5 > The Mismeasurement of Quality by Readmission Rate: How Blun...
Medical Care:
doi: 10.1097/MLR.0b013e31828d1275
Original Article

The Mismeasurement of Quality by Readmission Rate: How Blunt Is too Blunt an Instrument?: A Quantitative Bias Analysis

Rumball-Smith, Juliet MBChB, MPH, PhD, FAFPHM*,†; Blakely, Tony MBChB, MPH, PhD, FAFPHM; Sarfati, Diana MBChB, MPH, FNZCPHM; Hider, Phil MBChB, MPH, FAFPHM

Collapse Box


Background: The rate of readmission is widely used as a measure of hospital quality of care, often with funding implications for outlying facilities.

Objectives: This study explored the plausibility of readmission as a proxy for health care quality with quantitative bias analysis and the application of a structural Directed Acyclic Graph framework. It applies this paradigm to observed ethnic differences in the odds of readmission in a sample of New Zealand hospital patients.

Research Design: Ethnicity was defined as the exposure, readmission rate as the proxy outcome, and quality of care as a missing mediator. Using data from 89,090 surgical patients from New Zealand, and estimates from the literature of the prevalence of “poor quality” and the strength of the quality-of-care readmission association, a series of sensitivity analyses were performed to calculate an odds ratio of the ethnicity-readmission association corrected for the missing mediator “quality.”

Results: Given the assumptions applied, potentially only 29% of the excess odds of readmission for Māori compared with Europeans were due to poor quality of care.

Conclusions: This investigation finds substantial error when using readmission as a marker of quality, and suggests that differences in readmission between populations are more likely to be due to factors other than quality of care.

© 2013 Lippincott Williams & Wilkins, Inc.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.