Plan All-Cause Readmissions (PCR)

Assesses the rate of adult acute inpatient and observation stays that were followed by an unplanned acute readmission for any diagnosis within 30 days after discharge among commercial (18 to 64), Medicaid (18 to 64) and Medicare (18 to 64, 65 and older) health plan members. A separate readmission rate for hospital stays discharged to a skilled nursing facility (SNF) among members aged 65 and older is reported for Medicare plans. As well as reporting observed rates, NCQA also specifies that plans report an expected count of readmissions, predicted using members’ prior and current health, among other factors. The observed event count and expected event count are used to calculate a calibrated observed-to-expected (O/E) ratio that assesses whether plans had more, the same or fewer readmissions than predicted by their case mix, while accounting for incremental improvements across all plans over time. An O/E ratio below 1 indicates better-than-average performance and an O/E ratio above 1 indicates worse-than-average performance.

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. Unplanned readmissions are associated with increased mortality and higher health care costs. Unplanned readmissions can be prevented by standardizing and improving care coordination after discharge and increasing support for patient self-management.¹

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.