Appendix 1. Planned vs. Unplanned Readmission Algorithm Used by Centers for Medicare
and Medicaid Services (CMS) Hospital-Wide All Condition 30-Day Risk Standardized
Readmission Measure(27)
1
Appendix 2. University HealthSystem Consortium (UHC) Relatedness Criteria: Top Five Reasons for Clinically-Related
Unplanned Readmissions among Medical and Surgical Index Discharges, VA Fiscal Years 03-07
Relatedness
Reason
Index DRG =
Readmission
DRG
Index APRDRG =
Readmission
APR-DRG
Medical Index Discharges
DRG
Heat failure & shock
Chronic obstructive pulmonary
disease
Disorders of pancreas except
malignancy
Cirrhosis & alcoholic hepatitis
Simple pneumonia & pleurisy age
>17
APR-DRG
Heart failure
Chronic obstructive pulmonary
disease
Angina pectoris & coronary
atherosclerosis
Cardiac arrhythmia & conduction
disorder
Alcohol abuse & dependence
n
%
Surgical Index Discharges
n
%
5,883
13.9
82
7.1
4,229
10.0
72
6.2
1,356
3.2
65
5.6
1,345
1,326
3.2
3.1
Biopsies of musculoskeletal system & connective tissue
with complications
Major joint and limb reattachment procedures of the
lower extremity
Other vascular procedures with major complications and
comorbidities
Other vascular procedures without major complications
Amputation for musculoskeletal system & connective
tissue disease with major complications and
comorbidities
56
54
4.8
4.7
6,220
4,370
13.4
9.4
Other vascular procedures
Amputation of lower limb except toes
341
102
15.7
4.7
2,035
4.4
Urethral & transurethral procedures
94
4.3
1,634
3.5
Percutaneous cardiovascular procedures without AMI
92
4.2
1,593
3.4
Hip joint replacement
91
4.2
2
Appendix 2. University HealthSystem Consortium (UHC) Relatedness Criteria: Top Five Reasons for Clinically-Related
Unplanned Readmissions among Medical and Surgical Index Discharges, VA Fiscal Years 03-07 (cont.).
Relatedness
Reason
Medical Index Discharges
ICD-9-CM Dx code
Infection and inflammatory reaction due
to vascular device, implant and graft
Readmission Other postoperative infections
principal Dx
Other complications due to vascular
is a
device, implant, and graft
complication
Hematoma complicating a procedure
of care
Other complications due to renal dialysis
device implant and graft
CCS Dx code
Congestive heart failure;
nonhypertensive
Chronic obstructive pulmonary disease
Index
and bronchiectasis
principal Dx Pneumonia (except that caused by
=
tuberculosis or sexually transmitted
Readmission disease)
principal Dx
Alcohol-related disorders
Coronary atherosclerosis and other heart
disease
n
%
851
13.3
723
398
Surgical Index Discharges
n
%
Other postoperative infections
3,756
32.3
11.3
6.2
Disruption of external operation (surgical) wound
Hematoma complicating a procedure
647
625
5.6
5.4
292
273
4.6
4.3
Infection (chronic) of amputation stump
Surgical complications - digestive system
620
597
5.3
5.1
6,550
12.7
Complication of device; implant or graft
790
14.5
4,192
8.1
Complications of surgical procedures or medical care
469
8.6
2,164
4.2
Coronary atherosclerosis and other heart disease
387
7.1
1,781
1,759
3.4
3.4
Congestive heart failure; nonhypertensive
Cardiac dysrhythmias
206
179
3.8
3.3
3
Appendix 2. University HealthSystem Consortium (UHC) Relatedness Criteria: Top Five Reasons for Clinically-Related
Unplanned Readmissions among Medical and Surgical Index Discharges, VA Fiscal Years 03-07 (cont).
Relatedness
Reason
Index
principal
procedure =
Readmission
principal
procedure
Medical Index Discharges
CCS procedure code
Blood transfusion
n
%
Surgical Index Discharges
3,465
16.5
Electrocardiogram
Other respiratory therapy
2,317
1,940
11.0
9.2
Other therapeutic procedures
1,931
9.2
Alcohol and drug
rehabilitation/detoxification
1,348
6.4
Other operating room procedures on vessels other than
head and neck
Amputation of lower extremity
Percutaneous transluminal coronary angioplasty
(PTCA)
Insertion; revision; replacement; removal of cardiac
pacemaker or cardioverter/defibrillator
Transurethral excision; drainage; or removal urinary
obstruction
n
%
300
13.6
249
127
11.3
5.8
126
5.7
104
4.7
Note: These five criteria are not mutually exclusive.
*CCS indicates Agency for Healthcare Research and Quality’s Clinical Classifications System.(31)
4
Appendix 3. Sensitivity Analyses: Top Five Reasons for Unplanned Readmissions among Medical and Surgical Index
Discharges (Excluding Repeat Observations), VA Fiscal Years 03-07
Index
Discharges
UHC
Relatedness
All
N=175,896
Medical
Index
Discharges
ClinicallyRelated
N=73,834
Unrelated
N=102,062
All
N=41,871
Unplanned Readmission Principal Diagnoses Grouped by AHRQ’s Clinical Classifications System(31)
1
2
3
4
5
N, %
Non-hypertensive
CHF
(9,549, 7.2)
Non-hypertensive
CHF
(5,003, 9.1)
Pneumonia
(6,432, 4.8)
COPD
(3,218, 5.9)
Non-hypertensive
CHF
(4,546, 5.8)
Pneumonia
(4,197, 5.3)
Complications of
Procedures
(8,543, 21.7)
Complications of
Procedures
(8,139, 52.6)
Complications
of Devices
(2,801, 7.1)
Complications
of Devices
(2,708, 17.5)
COPD
(5,490, 4.1)
Dysrhythmia
(3,827, 2.9)
Fluid and Electrolyte
Disorders
(3,810, 2.9)
Complications of
Devices
(2,801, 5.1)
Fluid and
Electrolyte
Disorders
(2,932, 3.7)
Non-hypertensive
CHF
(1,553, 3.9)
Coronary
Atherosclerosis
(371, 2.4)
Complications of
Procedure
(2,333, 4.3)
Pneumonia
(2,235, 4.1)
UTI
(2,640, 3.4)
Acute Renal
Failure
(2,514, 3.2)
UTI
(1,213, 3.1)
Pneumonia
(1,156, 2.9)
Non-hypertensive
Cancer of bronchus;
CHF
lung
(218, 1.4)
(179, 1.2)
Fluid and
Non-hypertensive
UTI
Pneumonia
Electrolyte
Chest pain
Unrelated
CHF
N=25,235
(1,112, 4.7)
(1,088, 4.6)
Disorders
(904, 3.8)
(1,335, 5.6)
(1,070, 4.5)
UHC=University HealthSystem Consortium; AHRQ=Agency for Healthcare Research and Quality; CHF=Congestive Heart Failure;
UTI=Urinary Tract Infection; COPD=Chronic Obstructive Pulmonary Disease
Surgical
Index
Discharges
ClinicallyRelated
N=16,636
5