NR 588 Week 4 Shared Metric Proposal Example

Shared Metric Proposal: Thirty-Day Readmission for Patients Discharged From the Hospital to Maple Grove, Defined So Both Organizations Count It the Same Way

Student Name

College of Nursing, Chamberlain University

NR 588: Advanced Nursing Leadership Across Complex Systems

Instructor Name

Month Day, Year

Shared Metric Proposal: Thirty-Day Readmission for Patients Discharged From the Hospital to Maple Grove, Defined So Both Organizations Count It the Same Way

The Measure

Thirty-day unplanned readmission rate among patients discharged from our hospital directly to Maple Grove.

The Definition

Index stay: an inpatient discharge from our hospital, of a patient aged 18 or over, with discharge disposition recorded as Maple Grove.

Exclusions from the index: patients who leave against medical advice, patients transferred to another acute hospital, patients who die before discharge and patients enrolled in hospice at discharge.

Readmission: an inpatient admission to any acute care hospital within 30 days of the index discharge date. Observation stays and emergency department visits without admission are not counted as readmissions but are reported separately.

Planned readmissions, such as scheduled chemotherapy or elective surgery, are excluded using the planned readmission algorithm used in Medicare's readmission measures (Horwitz et al., 2015).

Each index stay counts once. If a patient has two readmissions within 30 days, only the first counts. A readmission can itself be an index stay if the patient is discharged back to Maple Grove.

Period: calendar month of index discharge, reported as a rolling three-month rate because monthly counts are small.

Rate: readmissions divided by index stays, as a percentage.

Which System Each Number Comes From

Index stays: our hospital's electronic health record, discharge disposition field.

Readmissions to our hospital: the same record.

Readmissions to other hospitals: the regional health information exchange's admission notifications, which cover all six acute hospitals within 40 miles.

Maple Grove's transfer log: the facility's electronic record, which records every transfer to a hospital with date, time, reason and whether the patient was admitted. Maple Grove supplies this to check our count and to add the transfer reason, which our records do not hold.

Who Runs Each Extract, and When

Our quality analyst runs the hospital extract and the exchange query on the 10th working day of each month, for index discharges three months earlier, so that every 30-day window has closed and late notifications have arrived.

Maple Grove's minimum data set coordinator sends the transfer log for the same patients by the 8th working day.

The analyst matches the two by patient name, date of birth and transfer date, and sends the reconciled report to both directors of nursing by the 15th working day.

Whose Figure Wins a Disagreement

Whether a readmission occurred: the hospital record or the exchange notification decides, because an admission is recorded by the admitting hospital.

Why the patient was transferred: Maple Grove's log decides, because its nurses recorded the reason at the time.

If the two records disagree about whether a patient was admitted, the analyst checks the admitting hospital's record through the exchange and notes the correction. If a disagreement cannot be resolved in five working days, the patient is counted as readmitted and the case is reviewed at the monthly meeting.

Why Not Use the Published Measure

Medicare publishes a readmission measure for each skilled nursing facility, and it is the one that affects Maple Grove's payments. But it covers patients from every hospital, is risk adjusted and arrives more than a year late. Our measure is narrower, unadjusted and available within three months, which suits a pilot. Mor et al. (2010) showed that rates from nursing facilities vary widely by facility and hospital, so a measure limited to our patients at one facility tells both partners what they can act on.

The Cost of Counting It

Our analyst: about four hours a month once the report is built, plus about 16 hours to build it.

Maple Grove's coordinator: about one hour a month to export and send the log.

Monthly review at the joint meeting: 15 minutes.

The exchange query has no added cost; our hospital already pays for exchange membership.

Baseline

The baseline uses the same definition and sources as the monthly report. Applying this definition to July 2025 to June 2026: 418 index stays, 96 readmissions, 23.0%. A further 41 emergency department visits and 18 observation stays did not count as readmissions. The baseline was checked against Maple Grove's log for three months, and two readmissions to other hospitals that the exchange had missed were added.

What the Metric Cannot Show

It does not adjust for how sick patients are, so a month with more complex discharges will look worse. It does not show whether a readmission was avoidable. Transfer reasons from Maple Grove's log will be used to review avoidability case by case, not to adjust the rate.

How the Measure Will Be Used

At each monthly review, the directors of nursing look at three things: the rolling rate against the 23.0% baseline, the list of readmissions with Maple Grove's transfer reasons and any case either side thinks was avoidable. The rate tells them whether the pilot is moving the result. The list tells them why. Avoidable cases are discussed by name, with the nurse practitioner present, and any change to discharge or facility practice is recorded. The measure is not used to compare individual nurses or to judge Maple Grove against other facilities, because it was not built for either purpose.

Testing the Definition

Before signing, the analyst and Maple Grove's coordinator each applied the definition independently to the same three months of patients. They disagreed on four of 104 index stays. Three were observation stays that one side had counted as readmissions; the definition now says plainly that observation stays are reported separately. One was a patient readmitted on day 31, counted by one side because of a time zone difference in the exchange feed; the analyst now uses the admission date only. After these changes, both counts matched.

Where Classrooms Differ

Some sections may ask for a risk-adjusted measure. Adjustment would make the figure fairer but slower and harder for Maple Grove to check. If adjustment is required, I would add it as a second, quarterly figure rather than replace the simple monthly one.

Agreement Requested

The definition is kept short deliberately, so either director of nursing can explain it to a board in one sentence.

Both directors of nursing sign this definition before the pilot starts, and any change requires both signatures. Rahman et al. (2013) found that hospital and facility pairs with stronger working ties had better outcomes; a measure both sides trust is part of that tie.

References

Horwitz, L. I., Grady, J. N., Cohen, D. B., Lin, Z., Volpe, M., Ngo, C. K., Masica, A. L., Long, T., Wang, J., Keenan, M., Montague, J., Suter, L. G., Ross, J. S., Drye, E. E., Krumholz, H. M., & Bernheim, S. M. (2015). Development and validation of an algorithm to identify planned readmissions from claims data. Journal of Hospital Medicine, 10(10), 670-677. https://doi.org/10.1002/jhm.2416

Mor, V., Intrator, O., Feng, Z., & Grabowski, D. C. (2010). The revolving door of rehospitalization from skilled nursing facilities. Health Affairs, 29(1), 57-64. https://doi.org/10.1377/hlthaff.2009.0629

Rahman, M., Foster, A. D., Grabowski, D. C., Zinn, J. S., & Mor, V. (2013). Effect of hospital-SNF referral linkages on rehospitalization. Health Services Research, 48(6, Pt. 1), 1898-1919. https://doi.org/10.1111/1475-6773.12112