View source for Readmission to MedWard

{{Reporting Indicators
| description = Number of Ward readmission within 7 days per 100 discharges from discharging hospital.
| indicator_name = Readmission Rate to Med ward
| created_raw = Created  
| program = Medicine
| indicator_start_date = 
| indicator_end_date = 
}}

==QI domain==
* [[QualityDomain::Safe]]

==Reported as==
* Percent of total discharges from discharging hospital (Rate)

{{DJ | 
* when we were setting up [[LAU collection readmission data]] we realized that we are not clear on what exactly is included in a [[Discharged to community]]. We should decide how to define that and whether it should apply here and/or for other reports. 
}}
* List of individual patients for chart review

==Significance==
Unplanned readmissions are associated with worse patient outcomes. Most factors associated with an increased risk of readmission are patient and admission-specific. System related risk factors include discharge at night and ward occupancy at the time of discharge. Readmission may reflect premature transfer out of hospital due to errors in clinical judgment or system constraints.

==Sampling Plan / Procedure==
===Inclusion Criteria===
100% of all patients discharged from medicine ward to home/PCH, outside Winnipeg/Manitoba/Canada hospitals/facilities.

===Exclusion Criteria===
Excluding patients who 
* Left the '''earlier''' ward or unit against medical advice ([[Dispo]] = [[AMA]]) 
* Arrived on the '''later''' ward as [[Palliative patient]]: 
::{{palliative patient}}

===Frequency===

===SAS definition===
{{Collapsable| always=As per 2025-02-14 email from JM
|full=
&nbsp; <!-- fix formatting for first line -->
    if (0 le diff le 7)   /* within one week included */
        and ( 
            tolocation in ('Home','HSC Lennox Bell') 
            OR   toloctype in ('hospice','PCH','ambulatory care')  
            OR   toregion in ('out-of-WPG','out-of-MB','out-of-CAN') 
            /* left the hospital and went home, long-term care facility, outside city and prov */
 
            or ( lagFromLoctype in ('ER','ambulatory care' )  
                /*  (came from ER or ambulatory care)
                     
                and ( lagPreInptLocation in ('NA / not applicable',' ')  
                    or lagInptRegion in ('out-of-WPG','out-of-MB','out-of-CAN') 
                    )
                    /* was (not an in-patient or in-patient from outside of Winnipeg before that)
               
                or lagFromHospital in ('Children'
                                          ,'Misericordia'
                                          ,'Manitoba Adolescent Treatment Center'
                                          ,'River Ridge Transition Care Environment'
                                          )
                                          /* or Children & Misericordia */
                )                    
                    
            or   lagFromLocation in ('Home' ) 
            /* next admit from Home */
             
            or  lagFromLoctype in ('PCH') 
            /* next admit from nursing home */
        )
    then readm7=1; 
 
    else readm7=0;  /* discharged to hospital ward,ICUs,OR,RR excluded*/
 
    if AMA=1 and readm7=1 then readm7=0;  /* AMA is excluded to readmission */
    if palliative=1  and readm7=1 then readm7=0;  /*palliative excluded */
 
    /* EMIP pts moving to another ward is not readmission */
    if Ward='EMIP' and (0 le diff le 7) and lagfromloctype in ('ER') then do; 
    readm7=0; end;
 
    /* Same Visit_Admit_DtTm is not readmission */
    if nextvisit=Visit_Admit_DtTm then do;
    readm7=0; end;
 
}}

==Definition and Derivation==
For medicine, a readmission is a patient where
* (current [[Admit DtTm | admit date/time]]) - (most recent [[Dispo DtTm | discharge date/time]] to the hospital) is within 7 days after their most recent discharge date time to the hospital
* is admitted from outside hospital
Readmission is attributed to the site or hospital from which the patient was discharged.
===Numerator===
Num = Number of ward readmission  within 7 days after being discharged out

===Denominator===
Denom =Total Number of discharges who left the hospital (e.g. went home/nursing home, outside city, province or country)
===Formula===
Readmission Rate(%) = Num / Denom * 100
===Example===
*Time Reference: Discharge Dates from Jan 1, 2017 to March 31, 2017
*Total readmission within 7 days after discharge to hospital= 5
*Total discharges who left the hospital= 102
*Readmission Rate(%)  = 5 / 102 * 100= 4.9 %

==Data Sources==
The following fields: 
[[Admit DtTm]], [[Dispo DtTm field]], [[Dispo field]],  the Project [[Comfort Care]] from L_TmpV2 table and diagnosis code [[Palliative Service]] from L_DXs table, ICD10 code Z51.5 [[Palliative care]] from L_ICD10 table are used. Julie has confirmed this setup 2022 April 21.

==SAS Program==
{{S:\MED\MED_CCMED}}Julie\SAS_CFE\CFE_macros\medreadm.sas

==Report Users==
*Medicine Directors and Site  Managers
*Medicine Standards Committee - Dr. Elizabeth Salamon 

== Related articles == 
{{Related Articles}}

[[Category:Data Use]]
[[Category:Reporting]]
[[Category:Statistical Analysis]]
[[Category:Multiple Encounter linking]]