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Hospital 30-Day Risk-Standardized Readmission Rates following Percutaneous Coronary Intervention (PCI)

CBE ID
0695
Endorsement Status
E&M Committee Rationale/Justification

Endorsement was removed due to no consensus. The committee raised concern with the lack of updated data to determine whether a gap exists and for scientific acceptability. The measure is also not in use, which makes it challenging to know if the measure is improving over time.

1.0 New or Maintenance
Previous Endorsement Cycle
Is Under Review
No
1.6 Measure Description

This measure estimates a hospital-level risk-standardized readmission rate (RSRR) following PCI for Medicare Fee-for-Service (FFS) patients who are 65 years of age or older. The outcome is defined as unplanned readmission for any cause within 30 days following hospital stays. The measure includes both patients who are admitted to the hospital (inpatients) for their PCI and patients who undergo PCI without being admitted (outpatient or observation stay). A specified set of planned readmissions do not count as readmissions. The measure uses clinical data available in the National Cardiovascular Disease Registry (NCDR) CathPCI Registry for risk adjustment and Medicare claims to identify readmissions. Additionally, the measure uses direct patient identifiers including Social Security Number (SSN) and date of birth to link the datasets. 

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
Yes
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.9 Care Setting
1.10 Measure Rationale

Not applicable

1.20 Types of Data Sources
1.25 Data Source Details

This measure relies on claims data. As of Fall 2023 claims data use is currently restricted and unavailable to support performance measures. Legislation to change this has been introduced.  

 

We used the following data sources for initial model development:  
1) Medicare Part A data  

IMPORTANT NOTE: ACC is not currently able to use this data source as Medicare claims are not currently available for performance measure reporting. This has limited our ability to update and report this measure.  

 
Part A data refers to claims paid for Medicare inpatient hospital care, outpatient services, skilled nursing facility care, some home health agency services, and hospice care. For this measure, we used Part A data to identify patient stays with a PCI performed either as an inpatient admission or outpatient service. For model development, we used 2007 Medicare Part A data to match patient stays associated with a PCI with comparable data from the CathPCI Registry. For validation, we used 2006 Medicare Part A data to match patient stays with a PCI performed with the corresponding 2006 data from the CathPCI Registry.  
 
2) Medicare Enrollment Database  
This database contains Medicare beneficiary demographic, benefit/coverage, and vital status information. This dataset was used to obtain information on several inclusion/exclusion indicators such as Medicare status on admission as well as vital status. These data have previously been shown to accurately reflect patient vital status (Fleming et al., 1992).  
 
3) NCDR CathPCI Registry  
The CathPCI Registry is the largest voluntary cardiovascular data registry in the United States. The registry captures detailed information about patients at least 18 years of age undergoing cardiac catheterization and PCI. Information collected by the registry includes demographics, comorbid conditions, cardiac status, and coronary anatomy. Hospitals that join the CathPCI Registry agree to submit data for 100% of patients undergoing cardiac catheterization and PCI procedures. These data are collected by hospitals and submitted electronically on a quarterly basis to NCDR.  

Reference:  
Fleming C, Fisher ES, Chang CH, Bubolz TA, Malenka DJ. Studying outcomes and hospital utilization in the elderly: The advantages of a merged data base for Medicare and Veterans Affairs hospitals. Medical Care. 1992; 30(5): 377-91. Data sources for the all-payer update