Plan All-Cause Readmissions (PCR)

For persons 18 years of age and older, the risk-adjusted ratio of observed-to-expected unplanned acute readmissions (inpatient and observation stays) for any diagnosis within 30 days of an acute hospitalization (inpatient and observation stays).  

Why It Matters

A “readmission” occurs when a patient is discharged from the hospital and then admitted back into the hospital within a short period of time. A high rate of patient readmissions may indicate inadequate quality of care in the hospital and/or a lack of appropriate post-discharge planning and care coordination.  

Poor care coordination at discharge can lead to adverse events for patients and avoidable rehospitalization. Readmission to the hospital within 30 days of discharge is frequently avoidable and can lead to adverse outcomes for patients ⁽¹⁾. Any preventable hospitalization can have a negative impact on health outcomes, particularly for older adults and adults with multiple chronic conditions. Health risks associated with hospitalization include infection, adverse drug events, loss of function, isolation and negative quality of life, and readmission. 

Hospital readmissions may indicate poor care or missed opportunities to coordinate care better. Research shows that specific hospital-based initiatives to improve communication with beneficiaries and their caregivers, coordinate care after discharge and improve the quality of care during the initial 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 ⁽²⁾. This measure assesses the number of acute inpatient and observation stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days for members 18 years of age and older 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.  

An increasing proportion of Medicare beneficiaries require the care offered in skilled nursing facilities (SNF) after a hospitalization to ensure a safe and successful transition back to the community. Readmission among those receiving skilled nursing care is associated with a two-times higher odds of not returning to the community within 100 days and is shown to be the strongest predictor of death among older adults requiring skilled nursing care ^(3,4). This measure includes a separate rate of readmission for Medicare beneficiaries requiring skilled nursing care after a hospitalization to highlight the quality and coordination of services for individuals experiencing this trajectory of care. 

Historical Results – National Averages

Performance results for this measure are currently unavailable. Visit our Quality Compass page to explore data licensing options and gain access to detailed performance results for this measure.