• This is a Healthcare Effectiveness & Data Information Set (HEDIS®) administrative measure and only includes Medicaid Primary beneficiaries.
• The annual reported rate captures activity during the stated measurement year (MY).

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

Discharge from a hospital is a critical transition point in a patient's care.  Poor care coordination at discharge can lead to adverse events for patients and avoidable rehospitatlization.  Hospital readmissions may indicate poor care or missed opportunities to coordinate care better.  Research shows that specific hospital-based inititiaves to improve communication with beneficiaries and their caregivers, coordinate care after discharge and improve the quality of care during the inital admission can avert many readmissions.

There is extensive evidence about adverse events in patients, and this measure aims to distinguish readmissions from complications of care and pre-existing comorbidities.  This measure assesses the number of actue inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days for members 18 -64 years of age in the following categories:

• Count of Index Hospital Stays (denominator)
• Count of 30 Day Readmissions (numerator)
• Average Adjusted Probability of Readmission

"Potentially preventable readmissions" are defined as readmissions that are directly tied to conditions that could have been avoided in the inpatient setting  While not all preventable readmissions can be avoided, most potentially preventable readmissions can be prevented if the best quality of care is rendered and clinicians are using current standards of care.

Last updated:  February 2020