The mismeasurement of quality by readmission rate: How blunt is too blunt an instrument?: A quantitative bias analysis

Abstract

BACKGROUND: The rate of readmission is widely used as a measure of hospital quality of care, often with funding implications for outlying facilities. OBJECTIVES: This study explored the plausibility of readmission as a proxy for health care quality with quantitative bias analysis and the application of a structural Directed Acyclic Graph framework. It applies this paradigm to observed ethnic differences in the odds of readmission in a sample of New Zealand hospital patients. RESEARCH DESIGN: Ethnicity was defined as the exposure, readmission rate as the proxy outcome, and quality of care as a missing mediator. Using data from 89,090 surgical patients from New Zealand, and estimates from the ..