Validation of New Readmission Data in the American College of Surgeons National Surgical Quality Improvement Program

BACKGROUND: Hospital readmissions are gathering increasing attention as a measure of health care quality and as a cost-saving target. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) recently began collecting data related to 30-day postoperative readmissions. Our objectives were to assess the accuracy of the ACS NSQIP readmission variable by comparison with the medical record, and to evaluate the readmission variable against administrative data. STUDY DESIGN: Readmission data captured in ACS NSQIP at a single academic institution between January and December 2011 were compared with data abstracted from the medical record and administrative data. RESULTS: Of 1,748 cases captured in ACS NSQIP, 119 (6.8%) had an all-cause readmission event identified, and ACS NSQIP had very high agreement with chart review for identifying all-cause readmission events (kappa = 0.98). For 1,110 inpatient cases successfully matched with administrative data, agreement with chart review for identifying all-cause readmissions was also very high (kappa = 0.97). For identifying unplanned readmission events, ACS NSQIP had good agreement with chart review (kappa = 0.67). Overall, agreement with chart review on cause of readmission was higher for ACS NSQIP (kappa = 0.75) than for administrative data (kappa = 0.46). CONCLUSIONS: The ACS NSQIP accurately captured all-cause and unplanned readmission events and had good agreement with the medical record with respect to cause of readmission. Administrative data accurately captured all-cause readmissions, but could not identify unplanned readmissions and less consistently agreed with chart review on cause. The granularity of clinically collected data offers tremendous advantages for directing future quality efforts targeting surgical readmission. (J Am Coll Surg 2013;216:420-427. (C) 2013 by the American College of Surgeons)