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Hospital Readmissions and Measures of Quality

Kenneth R. Dardick, MD; Judith A. Stein, JD
JAMA. 2012;307(4):361-362. doi:10.1001/jama.2012.11.
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To the Editor: A Commentary by Drs Kangovi and Grande discussed factors that influence hospital readmission rates.1 Patients who are cared for under observation status are not counted in readmission rates. Medpac reported that from 2006 to 2008 the number of hours attributed to observation increased by 32%.2

Kangovi and Grande stated, “CMS [Centers for Medicare & Medicaid Services] should monitor . . . observation service use . . . ”, yet their Figure ignores this and they do not discuss how this would affect their conclusions. No discussion of readmission rates can be considered valid without taking into account those hospital stays that are counted as observation and which may lead to an underestimation of readmission rates by as much as 32%.


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January 25, 2012
Shreya Kangovi, MD; David Grande, MD, MPA
JAMA. 2012;307(4):361-362. doi:10.1001/jama.2012.12.
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