Appendix 1: Supplementary tables [posted as supplied by author]

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1 Appendix 1: Supplementary tables [posted as supplied by author] Table A. International Classification of Diseases, Ninth Revision, Clinical Modification Codes Used to Define Heart Failure, Acute Myocardial Infarction, and Pneumonia Cohorts Cohort Name Constituent ICD-9-CM Codes Heart failure , , , , , , , , , 428.xx Acute myocardial infarction 410.xx excluding those with 410.x2 (AMI, subsequent episode of care) Pneumonia 480.x, 481, 482.xx, 483.x, 485, 486, 487.0, and ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification 1

2 Table B. Rehospitalizations Excluded from 30-day Readmission Measures by the Centers for Medicare & Medicaid Services Cohort Name Exclusions to 30-day Readmission Measures Heart failure 1. Readmissions for acute rehabilitation within 30 days of discharge (ICD-9-CM codes V57.xx) 2. Readmissions for a principal psychiatric disorder within 1 day of discharge (ICD-9-CM codes 29x.xx, 30x.xx, 31x.xx) Acute myocardial infarction 1. Readmissions for acute rehabilitation within 30 days of discharge (ICD-9-CM codes V57.xx) 2. Readmissions for a principal psychiatric disorder within 1 day of discharge (ICD-9-CM codes 29x.xx, 30x.xx, 31x.xx) 3. Planned readmissions for revascularization (percutaneous coronary transluminal angioplasty [PTCA] or coronary artery bypass grafting [CABG]). ICD 9 CM procedure codes associated with PTCA and CABG are: (1) 00.66, 36.01, 36.02, 36.05, 36.06, and for PTCA; (2) for CABG. Readmissions with a principal discharge diagnosis for HF, AMI, other acute/subacute forms of ischemic heart disease, arrhythmia, and cardiac arrest are not considered planned. The ICD 9 CM codes associated with HF, AMI, other acute/subacute forms of ischemic heart disease, arrhythmia, and cardiac arrest are: (1) HF: , , , , , , , , , 428.xx; (2) AMI: 410.xx, except 410.x2 (AMI, subsequent episode of care); (3) Other acute/subacute forms of ischemic heart disease: 411.xx; (4) Arrhythmia: 427.xx, except 427.5; (5) Cardiac arrest: Pneumonia 1. Readmissions for acute rehabilitation within 30 days of discharge (ICD-9-CM codes V57.xx) 2. Readmissions for a principal psychiatric disorder within 1 day of discharge (ICD-9-CM codes 29x.xx, 30x.xx, 31x.xx) AMI, acute myocardial infarction; CABG, coronary artery bypass grafting; HF, heart failure; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; PTCA, percutaneous coronary transluminal angioplasty 2

3 Table C. Modified Condition Category Constituents Modified Condition Category Number Constituent CMS and Name Condition Category Codes 1 - Heart failure Acute myocardial infarction Unstable angina and other acute 82 ischemic heart disease 4 - Chronic angina and coronary artery 83, 84 disease 5 - Valvular/rheumatic heart disease Other cardiac disease including 85, 87, 88, 94, 89, 90, 91 congenital heart and hypertensive disease 7 - Arrhythmias and conduction 92, 93 disorders 8 - Pleural effusion/pneumothorax Chest pain N/a (constituent ICD-9-CM 10 Syncope N/a (constituent ICD-9-CM 11 - Acute stroke/transient ischemic 95, 96, 97 attack 12 - Pulmonary embolism/deep venous N/a (constituent ICD-9-CM thrombosis 13 - Other peripheral vascular disease 104, 105, 106 (excluded ICD- 9-CM 14 - Cardio-respiratory failure 77, 78, Chronic obstructive pulmonary 108, 110 disease/asthma 16 - Pneumonia including aspiration 111, 112, 113 pneumonitis 17 - Septicemia/shock Urinary tract infection and urinary 135 system complaints 19 Cellulitis 152 Additional ICD- 9-CM Codes , , , , 453.4, , , , , , , , , , , , Exclude 415.1, , , 453.4, , , , , , , , , , , ,

4 20 - Clostridium difficile-associated N/a (constituent ICD-9-CM infection 21 - Renal disorders including renal 131, 23 failure and fluid, electrolyte, and acid-base abnormalities 22 Anemia Gastrointestinal hemorrhage N/a (constituent ICD-9-CM 24 - Diabetes and its complications 15, 16, 17, 18, 19, Fibrosis of lung and other chronic 109 lung disorders 26 - Hip fracture Complications of care 163, 164, Other lung disorders including acute, congenital, and unspecified lung 115 (additional ICD-9-CM abnormalities 29 - Primary cancer of the trachea, bronchus, lung, and pleura N/a (constituent ICD-9-CM , , , 531.2, , , , , 531.6, , , 532.0, , , 532.2, , , 532.4, , , 532.6, , , 533.0, , , 533.2, , , 533.4, , , 533.6, , , 534.0, , , 534.2, , , 534.4, , , 534.6, , , , , , , , , , 569.3, 578, 578.0, 578.1, , , , , , , , 162.3, 162.5, 162.8, 162.2, Other admitting diagnoses See below See below

5 Constituents of modified condition category 30 - other admitting diagnoses Other infections 1, 3, 4, 5, 6 Cancer 7, 8, 9, 10, 11, 12, 13, 14 Endocrine/metabolic 21, 22, 24 Liver disease 25, 26, 27, 28, 29 Digestive (Gastrointestinal) 30, 31, 32, 33, 34, 35, 36 (Excluded ICD-9-CM codes on right) Musculoskeletal 37, 38, 39, 40, 41, 42, 43 Other hematologic 44, 45, 46 Cognitive 48, 49, 50 Substance abuse 51, 52, 53 Psychiatric 54, 55, 56, 57, 58, 59, 60 Development disorders 61, 62, 63, 64, 65, 66 Spinal cord 67, 68, 69 Neuromuscular 70, 71, 72, 73, 74, 75, 76 Non-acute cerebrovascular disease 98, 99, 100, 101, 102, 103 Other pulmonary 107 Ophthalmologic 116, 117, 118, 119, 120, 121, Exclude 531.0, , , 531.2, , , , , 531.6, , , 532.0, , , 532.2, , , 532.4, , , 532.6, , , 533.0, , , 533.2, , , 533.4, , , 533.6, , , 534.0, , , 534.2, , , 534.4, , , 534.6, , , , , , , , , , 569.3, 578, 578.0, 578.1,

6 122, 123, 124 Ear, nose, and throat 125, 126, 127 Other renal 128, 129, 130, 132 Genitourinary 133, 134, 136, 137, 138, 139, 140 Obstetric 141, 142, 143, 144, 145, 146, 147 Other dermatologic 150, 151, 153 Injury excluding hip fracture 154, 155, 156, 157, 159, 160, 161, 162 (Excluded ICD-9- CM Symptoms (major and minor) excluding respiratory 166, 167 (Excluded ICD-9- CM Neonatal 168, 169, 170, 171, 172 Organ transplant 173, 174, 175 Miscellaneous surgical and non-surgical procedures 176, 177, 178, 179, 180, 181, 182 Durable medical equipment 185, 186, 187, 188, 189 Other 183, 184 Skin ulcer including decubitus ulcer 148, 149 Complications of care 163, 164, 165 Exclude 162.9, 162.3, 162.5, 162.8, 162.2, Exclude 780.2, 786.0, , , , , , , , 786.9, CMS, Centers for Medicare & Medicaid Services; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification 6

7 Table D. Modified Condition Category Codes for Cardiovascular Diagnoses Modified Condition Category Codes for Cardiovascular Diagnoses 1 - Heart failure 2 - Acute myocardial infarction 3 - Unstable angina and other acute ischemic heart disease 4 - Chronic angina and coronary artery disease 5 - Valvular/rheumatic heart disease 6 - Other cardiac disease including congenital heart and hypertensive disease 7 - Arrhythmias and conduction disorders 9 - Chest pain 10 Syncope 11 - Acute stroke/transient ischemic attack 12 - Pulmonary embolism/deep venous thrombosis 13 - Other peripheral vascular disease 7

8 Table E. Modified Condition Category Codes for Pulmonary Diagnoses Modified Condition Category Codes for Pulmonary Diagnoses 8 - Pleural effusion/pneumothorax 14 - Cardio-respiratory failure 15 - Chronic obstructive pulmonary disease/asthma 16 - Pneumonia including aspiration pneumonitis 25 - Fibrosis of lung and other chronic lung disorders 28 - Other lung disorders including acute, congenital, and unspecified lung abnormalities 29 - Primary cancer of the trachea, bronchus, lung, and pleura 8

9 Table F. Relationship of Hospital 30-day Risk-Standardized Readmission Rates with Readmission Diagnoses Following Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia Reason for Index Hospitalization Ranked Readmission Diagnoses Heart failure 1 - Heart failure 0.6% (0.5%, 0.8%) 2 - Renal disorders -0.2% (-0.3%, -0.0%) 3 - Pneumonia -0.0% (-0.1%, 0.0%) 4 - Arrhythmias -0.3% (-0.3%, -0.2%) 5 - Shock 0.1% (0.0%, 0.2%) 6 - Cardio-respiratory failure -0.2% (-0.2%, -0.1%) 7 - COPD 0.2% (0.1%, 0.2%) 8 - Chronic angina and CAD 0.0% (-0.0%, 0.0%) 9 - Acute myocardial infarction 0.0% (-0.0%, 0.0%) 10 - Complications of care -0.1% (-0.2%, -0.1%) Cardiovascular conditions 0.1% (-0.1%, 0.3%) Acute myocardial infarction 1 - Heart failure 0.1% (-0.1%, 0.4%) 2 - Acute myocardial infarction 0.0% (-0.1%, 0.2%) 3 - Renal disorders 0.1% (0.0%, 0.3%) 4 - Arrhythmias -0.2% (-0.3%, -0.1%) 5 - Chronic angina and CAD -0.1% (-0.2%, 0.1%) 6 - Pneumonia -0.1%, (-0.2%, 0.0%) 7 - Complications of care 0.0% (-0.1%, 0.1%) 8 - Shock 0.2% (0.1%, 0.3%) 9 - Cardio-respiratory failure -0.1% (-0.2%, 0.0%) 10 - Gastrointestinal hemorrhage -0.1% (-0.2%, 0.0%) Cardiovascular conditions -1.1% (-1.4%, -0.8%) Pneumonia 1 - Pneumonia -0.1% (-0.3%, 0.1%) 2 - Heart failure -0.0% (-0.1%, 0.1%) 3 - COPD 0.0% (-0.1%, 0.1%) 4 - Shock 0.1% (0.0%, 0.2%) 5 - Renal disorders 0.0% (-0.1%, 0.1%) 6 - Cardio-respiratory failure -0.3% (-0.4%, -0.2%) Coefficient for Change in Percentage of Readmissions due to Associated Diagnosis for Every 1 SD Increase in RSRR * in Univariate Analysis (95% CI) 7 - Arrhythmias and conduction -0.3% (-0.3%, -0.2%) disorders 8 - Clostridium difficile-associated 0.0% (-0.1%, 0.0%) infection 9 - UTI and urinary system -0.0% (-0.1%, 0.0%) complaints 10 - Gastrointestinal hemorrhage -0.1% (-0.2%, -0.1%) Pulmonary conditions -0.6% (-0.8%, -0.3%) * RSRR: risk standardized readmission rate over 3 years. For example, for the pneumonia readmission cohort, when RSRR increased by 1 standard deviation, the proportion of readmissions due to recurrent pneumonia decreased by 0.1%. CI, confidence interval; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; RSRR, riskstandardized readmission rate; UTI, urinary tract infection 9

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11 Table G. Relationship of Hospital Characteristics with Readmission Diagnoses Following Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia Reason for Index Hospitalization Ranked Readmission Diagnoses 30-day RSRR* Coefficient for Change in the Percentage of Readmissions due to the Associated Diagnosis in Multivariate Analysis Yearly % Medicaid % African- Rural Critical Teaching Safety Net Publicly Hospital American Hospital Access Hospital** Hospital Owned Volume Hospital Hospital Heart failure 1 - Heart failure 0.4% 0.2% 0.4% 0.7% 0.3% 0.5% 0.4% -0.3% 1.6% -0.2% 2 - Renal disorders -0.2% 0.2% -0.1% 0.1% 0.1% 1.4% 0.1% 0.0% 0.5% 0.5% 3 - Pneumonia 0.1% -0.1% -0.0% -0.4% 0.9% 3.0% -0.2% -0.1% 0.4% 0.4% Acute myocardial infarction 4 - Arrhythmias -0.2% 0.0% -0.1% -0.1% 0.1% 2.1% 0.1% 0.2% -0.2% 0.0% 5 - Shock 0.0% 0.0% 0.0% 0.1% 0.0% 1.9% -0.2% 0.2% -0.5% -0.2% 6 - Cardio-respiratory -0.2% 0.0% 0.1% 0.0% 0.4% 2.1% -0.2% 0.2% 0.1% 0.2% failure 7 - COPD 0.1% 0.0% 0.1% -0.0% 1.2% 2.4% -0.4% 0.0% 0.0% -0.1% 8 - Chronic angina and -0.1% -0.1% 0.1% -0.0% 0.9% 2.6% -0.1% -0.2% 0.0% -0.1% CAD 9 - Acute myocardial 0.0% -0.0% 0.1% -0.1% 0.6% 2.3% -0.2% -0.1% 0.1% -0.1% infarction 10 - Complications of care -0.1% 0.0% 0.0% 0.1% 0.5% 2.3% 0.3% 0.0% -0.2% -0.3% Cardiovascular conditions -0.0% 0.1% 0.3% 0.4% -0.1% 0.9% 0.3% -0.6% 1.7% -0.5% 1 - Heart failure 0.2% 0.4% -0.7% 0.1% -1.9% 2.9% 0.3% 1.0% -0.7% -0.3% 2 - Acute myocardial 0.0% 0.0% 0.1% -0.1% 6.6% 9.6% -1.4% 0.6% 0.6% 0.6% infarction 3 - Renal disorders 0.0% -0.1% 0.1% 0.4% 0.5% 8.6% 0.1% -0.3% 0.4% -0.1% 4 - Arrhythmias -0.1% 0.1% -0.0% -0.2% 1.2% 7.8% -0.3% 0.0% 0.2% -0.1% 5 - Chronic angina and -0.1% -0.1% 0.1% 0.0% 2.8% 1.6% -0.2% 0.4% -0.2% -0.3% CAD 6 - Pneumonia -0.1% -0.3% -0.0% -0.2% -0.6% 0.3% -0.3% -0.2% 0.0% 0.2% 7 - Complications of care 0.0% 0.1% 0.1% -0.2% -1.3% 0.2% 1.3% -0.4% -0.2% -0.8% 8 - Shock 0.1% -0.4% 0.1% 0.1% 1.0% -3.9% -0.4% 0.1% -0.4% 0.1% 9 - Cardio-respiratory -0.2% -0.3% 0.2% 0.1% 0.4% -0.4% -0.3% 0.0% 0.0% 0.3% failure 10 - Gastrointestinal -0.1% -0.2% -0.0% 0.1% -0.3% -0.9% -0.0% 0.1% -0.2% 0.0% hemorrhage Cardiovascular conditions -0.9% 0.2% 0.5% 0.3% 3.5% 0.9% -0.8% 0.6% 0.3% 0.0% Pneumonia 1 - Pneumonia 0.2% 0.1% 0.1% -1.0% 2.7% 3.7% -1.6% 0.3% 1.2% -0.3% 2 - Heart failure -0.1% 0.3% 0.2% 0.1% 0.2% 1.9% -0.5% 0.2% -0.1% 0.0% 3 - COPD 0.1% 0.1% 0.4% -0.3% 0.8% 1.4% -1.1% -0.2% -0.6% -0.7% 4 - Shock 0.0% -0.0% 0.2% 1.0% -0.4% 0.6% 0.1% 0.1% -1.1% -0.6% 5 - Renal disorders -0.1% -0.0% 0.0% 0.4% 0.2% 1.2% 0.2% -0.2% 0.5% 0.0% 6 - Cardio-respiratory -0.3% 0.0% 0.1% 0.0% 0.0% 0.9% -0.1% 0.3% 0.2% 0.3% failure 7 - Arrhythmias and -0.3% -0.2% -0.0% -0.0% 0.4% 1.5% -0.0% 0.0% -0.2% -0.1% conduction disorders 8 - Clostridium difficileassociated -0.0% -0.2% -0.2% -0.0% -0.3% 1.4% 0.1% 0.0% -0.1% 0.2% infection 9 - UTI and urinary system -0.1% -0.2% 0.1% 0.1% 0.5% 2.1% -0.1% -0.2% 0.0% -0.2% complaints 10 - Gastrointestinal -0.1% -0.2% 0.1% 0.0% 0.5% 1.5% -0.1% 0.0% -0.2% 0.0% hemorrhage Pulmonary conditions -0.1% 0.1% 0.6% -1.6% 2.8% 2.3% -2.7% -0.3% 1.3% -0.2% 11 Not for Profit Hospital

12 * 30-day RSRR: risk standardized readmission rate over 3 years. Coefficient describes the change in the proportion of 30-day readmissions due to the associated diagnosis for every 1 standard deviation increase in RSRR. For example, for the pneumonia readmission cohort, when RSRR increased by 1 standard deviation, the proportion of readmissions due to recurrent pneumonia increased by 0.2%. Yearly hospital volume: total number of hospitalizations for index condition from 2007 and 2009 divided by 3. Coefficient describes the change in proportion of 30-day readmissions due to the associated diagnosis for every increase in yearly hospital volume for the index condition by 1 standard deviation. % Medicaid: the proportion of patients with Medicaid health insurance cared for by the facility as defined using 2008 American Hospital Association (AHA) data. Coefficient describes the change in the proportion of 30-day readmissions due to the associated diagnosis for every 1 standard deviation increase in the proportion of hospital patients that have Medicaid health insurance. % African-American: the proportion of African-American patients cared for by the facility from 2007 and Coefficient describes the change in the proportion of 30-day readmissions due to the associated diagnosis for every 1 standard deviation increase in the proportion of hospital patients that are African-American. Rural hospital: Coefficient describes the change in the proportion of 30-day readmissions due to the associated diagnosis for hospitals considered rural rather than urban. Critical access hospital: Coefficient describes the change in the proportion of 30-day readmissions due to the associated diagnosis for hospitals considered critical access hospitals. ** Teaching hospital: Coefficient describes the change in the proportion of 30-day readmissions due to the associated diagnosis for hospitals considered teaching rather than non-teaching hospitals Safety net hospital: Coefficient describes the change in the proportion of 30-day readmissions due to the associated diagnosis for hospitals considered safety net hospitals. Publicly owned hospital: Coefficient describes the change in the proportion of 30-day readmissions due to the associated diagnosis for hospitals considered publicly owned rather than privately owned. Not-for-profit hospital: Coefficient describes the change in the proportion of 30-day readmissions due to the associated diagnosis for hospitals considered not-for-profit rather than privately owned. p-value: 0.001<p<0.01 p-value<0.001 CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; RSRR, risk-standardized readmission rate; UTI, urinary tract infection 12