• Patient-centred care
• Safety culture
• Quality improvement methodologies

Soong and Bell’s editorial1 questions whether preventable readmissions can be objectively defined and whether such measures represent a valid patient-centred indicator of quality.

Our experience of developing and publicly reporting outcomes in New South Wales (NSW), Australia, suggests that the debate about readmissions should be recast away from ascertaining whether or not a particular hospital readmission was preventable, towards assessing all hospital-level variation in readmission patterns. We agree with the assertion that all-cause readmission rates are less specific and include normally occurring events related to disease progression. They are subject to differences in patient case mix and so are strengthened considerably by the use of clearly defined patient cohorts and appropriate adjustment for patient-level factors.

Earlier this year, our organisation published a report using a 30-day risk-standardised readmission ratio (RSRR) indicator for five clinical conditions (acute myocardial infarction, ischaemic stroke, congestive heart failure, pneumonia and hip fracture surgery) and a 60-day RSRR for two surgical procedures (total hip replacement and total knee replacement). The report drew on linked data from hospital records and death registries covering 12 years (July 2000–June 2012) and highlighted outlier hospitals in the state.2

In developing our approach to measuring variation in readmissions, we conducted a wide-ranging review of current practices internationally. Our method was informed by …