Readmission Logic | HealthInfoNet Academy

Overview

HealthInfoNet applies proven value-add logic to participants' encounter records to flag which encounters are deemed index admissions/visits to subsequent unplanned readmission encounters to the same care setting. This helps patients' care teams track time-sensitive utilization to inform the best care decisions.

Note: Readmission logic only applies to Inpatient and Emergency Department encounter settings; the logic does not apply to the Long-Term Care encounter setting.

Measure Specifications

Specification	Inpatient 30-Day Unplanned Readmission	ED 30-Day Unplanned Readmission
Measure Steward	National Quality Forum (NQF)	Custom; based on Inpatient 30-Day Unplanned Readmission measure (NQF #1789)
Measure ID	NQF #1789	Custom; based on Inpatient 30-Day Unplanned Readmission measure (NQF #1789)
Denominator	All discharged Inpatient encounters (i.e., index Inpatient encounters)	All discharged Emergency Department encounters (i.e., index Emergency Department encounters)
Denominator Exclusions	Excludes Inpatient encounters if: Missing primary diagnosis code, age, or sex on record Blocked primary diagnosis code on record related to mental health services Discharge disposition code = Expired (20, 40, 41, 42), Home - Against Medical Advice (07), Rehabilitation Facility (62, 90) Discharged with Clinical Classification Software (CCS) primary diagnosis = Psychiatric or Cancer (AND does not have a major surgery procedure code) Discharged with CCS diagnostic category = Rehabilitation Discharged without 30 days of future data	Excludes Emergency Department encounters if: Missing primary diagnosis code, age, or sex on record Blocked primary diagnosis code on record related to mental health services Discharge disposition code = Expired (20, 40, 41, 42), Home - Against Medical Advice (07) Discharged without 30 days of future data
Numerator	All Inpatient encounters readmitted within 30 days of discharged index Inpatient encounters	All Emergency Department encounters readmitted within 30 days of discharged index Emergency Department encounters
Numerator Exclusions	Excludes Inpatient encounters if: Missing primary diagnosis code, age, or sex on record Readmission is planned Readmission is to rehabilitation units on the same day or next day after index Inpatient encounter discharge Readmission is a transfer from another acute care facility	Excludes Emergency Department encounters if: Missing primary diagnosis code, age, or sex on record Readmitted in less than 8 hours from index Emergency Department encounter
Additional Notes	If a patient has more than one (1) unplanned Inpatient encounter within 30 days of the discharged index Inpatient encounter, only the first subsequent Inpatient encounter is considered a readmission. If the first Inpatient encounter after the discharged index Inpatient encounter is planned, any subsequent unplanned Inpatient encounter is not considered a readmission of the discharged index Inpatient encounter. This is because the unplanned Inpatient encounter could be related to care provided during the intervening planned readmission rather than during the discharged index Inpatient encounter. Inpatient readmissions do not have to be at the same rendering facility/site as the index Inpatient encounter; a readmitted encounter rendered at any facility/site will count as a readmission if all of the above criteria is also met.	Emergency Department readmissions do not have to be at the same rendering facility/site as the index Emergency Department encounter; a readmitted encounter rendered at any facility/site will count as a readmission if all of the above criteria is also met. If a patient visits to the Emergency Department within 8 hours of an initial Emergency Department visit, and a subsequent unplanned Emergency Department readmission occurs within 30 days thereafter, both of the initial Emergency Department encounters will be counted as index encounters to the readmission.