Resurrecting immortal-time bias in the study of readmissions.

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2019
Article Quality & Performance Metrics
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Abstract
To compare readmission rates as measured by the Centers for Medicare and Medicaid Services and the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) methods.20 percent sample of national Medicare data for patients undergoing cystectomy, colectomy, abdominal aortic aneurysm (AAA) repair, and total knee arthroplasty (TKA) between 2010 and 2014.Retrospective cohort study comparing 30-day readmission rates.Patients undergoing cystectomy, colectomy, abdominal aortic aneurysm repair, and total knee arthroplasty between 2010 and 2014 were identified.Cystectomy had the highest and total knee arthroplasty had the lowest readmission rate. The NSQIP measure reported significantly lower rates for all procedures compared to the CMS measure, which reflects an immortal-time bias.We found significantly different readmission rates across all surgical procedures when comparing CMS and NSQIP measures. Longer length of stay exacerbated these differences. Uniform outcome measures are needed to eliminate ambiguity and synergize research and policy efforts.
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Authors Hugar, Lee A;Borza, Tudor;Oerline, Mary K;Hollenbeck, Brent K;Skolarus, Ted A;Jacobs, Bruce L;
Journal Health services research
Year 2019
DOI
10.1111/1475-6773.13252
URL
Keywords
surgery medicare program evaluation administrative data uses health policy/politics/law/regulation quality of care/patient safety

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