"Identifying Information: Name","30-Day Acute Myocardial Infarction Readmission"
"Identifying Information: Short/Other Names","Not applicable"
"Identifying Information: Description","This indicator provides the risk-adjusted rate of urgent readmission following discharge for acute myocardial infarction (AMI).For further details, please see the General Methodology Notes (PDF)."
"Background, Interpretation and Benchmarks: Rationale","Readmissions to acute care facilities are increasingly being used to measure institutional or regional quality of care and care coordination. Readmission rates after AMI can be influenced by a variety of factors, including the quality of inpatient and outpatient care, effectiveness of the care transition and coordination, or the availability of appropriate diagnostic or therapeutic technologies during the initial hospital stay. While not all urgent readmissions are avoidable, interventions during and after a hospitalization can be effective in reducing readmission rates."
"Background, Interpretation and Benchmarks: Interpretation","Lower rates are desirable."
"Background, Interpretation and Benchmarks: HSP Framework Dimension","Appropriate and effective"
"Background, Interpretation and Benchmarks: Areas of Need","Getting Better"
"Background, Interpretation and Benchmarks: Targets/Benchmarks","Not applicable"
"Available Data Years","2007
 to 2023"
"Available Data Years: Type of Year",Fiscal
"Availability of Results: Geographic Coverage","All provinces/territories"
"Reporting Level/Disaggregation",National
"Result Updates: Indicator Results","Web Tool:şěÁě˝íąĎ±¨ Indicators e-Publication "
"Update Frequency","Every year"
"Result Updates: Latest Results Update Date","December 2024"
"Result Updates: Updates","Not applicable"
"Indicator Calculation: Description","Risk-adjusted readmission rate for each region = Observed number of readmissions for each region Ă· Expected number of readmissions for the region Ă— Canadian average readmission rateUnit of analysis: Episode of careAn episode of care refers to all contiguous inpatient hospitalizations and same-day surgery visits. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if either of the following conditions is met:An acute care hospitalization or a same-day surgery visit occurs less than seven hours after discharge from the previous acute care hospitalization or same-day surgery visit, regardless of whether the transfer is coded;An acute care hospitalization or same-day surgery visit occurs between 7 and 12 hours after discharge from the previous acute care hospitalization or same-day surgery visit, and at least one of the hospitalizations or visits has coded the transfer."
"Indicator Calculation: Type of Measurement",Rate
"Indicator Calculation: Number or Rate","per 100"
"Denominator: Description:","Number of AMI episodes of care discharged between April 1 and March 1 of the fiscal year"
"Denominator: Inclusions:"," Acute myocardial infarction (AMI) (ICD-10-CA: I21, I22; ICD-9/ICD-9-CM: 410) is coded as most responsible diagnosis (MRDx) but not also as a diagnosis type (2); or Where another diagnosis is coded as MRDx and also as a diagnosis type (2), and a diagnosis of AMI is coded as a type (1) [type (C) for Quebec data] or (type (W), (X) or (Y) but not also as type (2)); or Where coronary artery disease (ICD-10-CA: I25.0, I25.1, I25.8, I25.9; ICD-9/ICD-9-CM: 429.2, 414.0, 414.8, 414.9) is coded as MRDx, AMI as type (1) [type (C) for Quebec data] or type (W), (X) or (Y) but not also as type (2); along with revascularization procedure (percutaneous coronary intervention–CCI: 1.IJ.50^^ ; 1.IJ.57.GQ^^ [this code is used for 2002–2003 to 2017–2018 data only]; 1.IJ.54.GQ-AZ [this code is used for 2006–2007 to 2008–2009 data only]; 1.IJ.57.GT*; 1.IJ.57.GU*; CCP: 48.02, 48.03; ICD-9-CM: 36.01, 36.02, 36.05; or coronary artery bypass–CCI: 1.IJ.76^^ ; CCP: 48.1^; ICD-9-CM: 36.1^).Episodes involving inpatient care. An episode may start or end in a day surgery setting. Episodes that both start and end in day surgery settings are not included.Discharge between April 1 and March 1 of the following year (period of case selection ends March 1 to allow for 30 days of follow-up)Age 18 and olderSex recorded as male or femaleUrgent/emergent episodes (Admission Category Code = U in any records within an episode)"
"Denominator: Exclusions:","Records with an invalid health card numberRecords with admission category of cadaveric donor or stillbirth (Admission Category Code = R or S)Records with an invalid code for province issuing health card numberRecords with an invalid admission date or timeRecords with an invalid discharge date or timeEpisodes with discharge as death (DAD Discharge Disposition Code = 07, 72*, 73*, 74*; NACRS Visit Disposition Code = 10, 11, 71*, 72*, 73*, 74*)Episodes with length of stay less than 24 hoursAMI episodes that are within 30 days of a previous AMI episodeNote*2018–2019 data onward."
"Numerator: Description:","Cases within the denominator with a readmission for any reason within 30 days of discharge after the index episode of care"
"Numerator: Inclusions:","Emergent or urgent (non-elective) readmission to an acute care hospital (Admission Category Code = U)"
"Numerator: Exclusions:","2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)"
"Method of Adjustment","Logistic regression"
"Adjustment Applied: Covariates used in risk adjustment:","For a detailed list of covariates used in the model, please refer to the Model Specification (PDF) document."
"Indicator Calculation: Geographic Assignment","Place of residence"
"Data Sources",DAD
"Quality Statement: Caveats and Limitations","Patients can appear in the denominator more than once if they have multiple episodes of care between April 1 and March 1 of the fiscal year.Planned readmissions reported as urgent admissions are included in the readmission rate."
"Quality Statement: Trending Issues","Not applicable"
"Quality Statement: Comments","Not applicable"
References,"Ashton CM, Wray NP. A Conceptual Framework for the Study of Early Readmission as an Indicator of Quality of Care. Soc Sci Med; 1996; 43: 1533-1541.Hosmer DW, Lemeshow S. Confidence Interval Estimates of an Index of Quality Performance Based on Logistic Regression Models. Stat Med 1995; 14: 2161-2172.Krumholz HM, et al. Hospital 30-Day Acute Myocardial Infarction Readmission Measure: Methodology. Baltimore, MD: Centers for Medicare & Medicaid Services; 2008. Accessed September 24, 2024."