Copyright 2013 Health Administration Press

Data for Chapter 4, Exercise #2 on Page 92 of

Healthcare Operations Management, Second Edition

Download the data for this chapter and develop a dashboard in Excel to identify readmissions

within 30 days. A number of initiatives are described on the companion website that can be used

to minimize readmissions. Do additional Internet research and then construct a strategy map to

improve this readmission rate.

Data Files and Exercise

The two Excel files attached to this PDF can be used for this exercise. They have been created by

CMS for use by individuals who want to analyze clinical information but cannot easily access

HIPAA-protected data. These data are synthesized by CMS to be statistically equivalent to

actual Medicare data but are not connected to any actual beneficiaries.

1. Medicare Synth DataRaw: This spreadsheet contains inpatient admission data. The

complete CMS files are very large, so this data set has been reduced to 2,000 admissions.

The data dictionary for this file is available here.

2. Medicare Synth Data with Readmissions Indicated: This second spreadsheet contains the raw

data from the first spreadsheet plus five additional columns (indicated in yellow). These

columns contain formulas that compare the patient IDs to identify admissions for each

patient. They then calculate the approximate length of time between admissions. Finally, the

last column indicates which readmissions were within 30 days. This information can be used

to develop a strategy for reducing readmissions. This calculation was done for the first 50

admissions only but can clearly be applied to the whole data file.

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/SynPUFs/Downloads/SynPUF_DUG.pdf

Copyright 2013 Health Administration Press

A useful, challenging exercise is to determine readmissions within 30 days from

spreadsheet #1 (the raw data) only. One can then extract the target admissions and do further

analysis on potential predictive indicators (e.g., age, DRG).

Readmission Reductions

Two resources provide many useful strategies for reducing readmissions:

1. Institute for Healthcare Improvement

2. National Association of Public Hospitals

Strategy Map

One practical readmissions reduction program was developed by Brian Jack, MD, and colleagues

at Boston University Medical Center. The program, called Project Re-Engineered Discharge

(RED), improves coordination of care at discharge.1

The project was implemented at an urban hospital that serves a low-income, ethnically

diverse population. A specially trained nurse called a discharge advocate facilitates a number of

interventions, including

educating the patient about his or her diagnosis throughout the hospital stay;

making appointments for clinician follow-up, test results follow-up, and post-discharge

testing;

organizing post-discharge services;

confirming the patients medication plan;

reconciling the discharge plan with national guidelines and clinical pathways;

providing the patient a written discharge plan and assessing the patients understanding of the

plan;

1Boutwell, A., F. Griffin, S. Hwu, and D. Shannon. 2009. Effective Interventions to Reduce Rehospitalizations: A Compendium of 15 Promising Interventions. Cambridge, MA: Institute for Healthcare Improvement.

http://www.ihi.org/explore/Readmissions/Pages/default.aspxhttp://www.naph.org/Main-Menu-Category/Our-Work/Quality-Overview/Reducing-Readmissions.aspx

Copyright 2013 Health Administration Press

informing the patient what he or she should do if a problem arises;

expediting transmission of the discharge resume (summary) to outpatient providers; and

calling the patient two to three days after discharge to reinforce the discharge plan and offer

solutions to any problems that may have arisen.

A strategy map for initiating a program such as Project RED is attached to this PDF.

Sheet1

DESYNPUF_IDCLM_IDSEGMENTCLM_FROM_DTCLM_THRU_DTSame Patient?PRVDR_NUMCLM_PMT_AMTNCH_PRMRY_PYR_CLM_PD_AMTAT_PHYSN_NPIOP_PHYSN_NPIOT_PHYSN_NPICLM_ADMSN_DTADMTNG_ICD9_DGNS_CDCLM_PASS_THRU_PER_DIEM_AMTNCH_BENE_IP_DDCTBL_AMTNCH_BENE_PTA_COINSRNC_LBLTY_AMNCH_BENE_BLOOD_DDCTBL_LBLTY_AMCLM_UTLZTN_DAY_CNTNCH_BENE_DSCHRG_DTCLM_DRG_CDICD9_DGNS_CD_1ICD9_DGNS_CD_2ICD9_DGNS_CD_3ICD9_DGNS_CD_4ICD9_DGNS_CD_5ICD9_DGNS_CD_6ICD9_DGNS_CD_7ICD9_DGNS_CD_8ICD9_DGNS_CD_9ICD9_DGNS_CD_10ICD9_PRCDR_CD_1ICD9_PRCDR_CD_2ICD9_PRCDR_CD_3ICD9_PRCDR_CD_4ICD9_PRCDR_CD_5ICD9_PRCDR_CD_6HCPCS_CD_1HCPCS_CD_2HCPCS_CD_3HCPCS_CD_4HCPCS_CD_5HCPCS_CD_6HCPCS_CD_7HCPCS_CD_8HCPCS_CD_9HCPCS_CD_10HCPCS_CD_11HCPCS_CD_12HCPCS_CD_13HCPCS_CD_14HCPCS_CD_15HCPCS_CD_16HCPCS_CD_17HCPCS_CD_18HCPCS_CD_19HCPCS_CD_20HCPCS_CD_21HCPCS_CD_22HCPCS_CD_23HCPCS_CD_24HCPCS_CD_25HCPCS_CD_26HCPCS_CD_27HCPCS_CD_28HCPCS_CD_29HCPCS_CD_30HCPCS_CD_31HCPCS_CD_32HCPCS_CD_33HCPCS_CD_34HCPCS_CD_35HCPCS_CD_36HCPCS_CD_37HCPCS_CD_38HCPCS_CD_39HCPCS_CD_40HCPCS_CD_41HCPCS_CD_42HCPCS_CD_43HCPCS_CD_44HCPCS_CD_45

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