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Presentation date
Summer 8-22-2025
College
College of Medicine
Abstract
Background: The 2010 Affordable Care Act (ACA) catalyzed a shift toward value-based care. This introduced reimbursement penalties tied to hospital performance metrics, such as the Hospital Readmission Reduction Program (HRRP) which deducts reimbursement for institutions with excessive 30-day readmission rates. Although more than 25% of hospital readmissions are considered potentially avoidable, the methods of evaluation are often inconsistent, and overlook medically complex patients and those who experience recurrent readmissions.
Objective: To identify methodologies used in current 30-day readmission studies and to propose improved methodological framework for population inclusion, demographic considerations, and statistical analysis to allow for proper risk stratification.
Methods: A scoping literature review across pulmonology, otolaryngology, nephrology, cardiology, and internal medicine to identify and map how 30-day readmissions are studied in various fields. Key characteristics such as determination of inclusion criteria, consideration of recurrent readmissions and competing risk of death, and presentation of patient demographics and socioeconomic disparities were examined and reported. Strengths of various statistical models such as Cox proportional hazards, Prentice-Williams-Peterson (PWP-TT), and Fine & Gray subdistribution hazard modeling were defined.
Results: Many studies fail to account for critically ill patient populations, multiple encounters, and demographic variability - vital metrics in quality improvement. Proper risk stratification must be done on readmissions in order to properly use 30-day readmits as a quality metric, distinguishing between avoidable readmissions and those that necessitate additional care.
Conclusion: This review presents a framework for designing and evaluating 30-day readmission studies. By outlining use cases for population inclusion criteria, demographic reporting, and statistical analysis methods, it supports improved study methodology through intentional design. This approach aims to enhance the validity of 30-day readmission studies as a value-based evaluation metric.
Keywords
Readmissions, methodology
Recommended Citation
Gervais, McKenna; Anderson, Kayley; Wardian, Jana; and Dowdall, Jayme, "How to Study 30-Day Readmissions: A Framework for Risk Stratification and Methodological Rigor" (2025). Medical Student Research Showcase. 6.
https://digitalcommons.unmc.edu/com_msrs/6