The hospital readmission rate is often considered an indicator of an undesirable patient outcome. You quality improvement team is located at a metropolitan hospital that serves a large population. The quality improvement team is conducting a study pertaining to readmissions, smoking and number of drugs administered to admitted patients with congestive heart failure (CHF). The team is interested in reducing the number of readmissions among patients discharged with a principal diagnosis of CHF. The team believes that the high admission rate is due to the difficulty that these patients have in controlling the number of drugs that they typically take. The team believes that by improving patient/family education regarding drug administration, the readmission rate could be reduced. Thus, they have developed the screen "CHF patients taking three or more drugs" to identify these patients before discharge. To evaluate the effectiveness of the measure, the team conducts a study on all CHF patients discharged the previous year. The results are shown below:

	CHF patients
Number of Drugs Administered	Readmitted	Not Readmitted	Total
3 drugs	200	40	240
<3 drugs	100	900	1000
Total	300	940	1240

A. Your team needs to decide how to measure the effectiveness of this measure. You think the best way would be to compute the values of the sensitivity, specificity and predictive value. Show your work and provide an interpretation of these measures.

B. On the basis of your results, is this an effective measure? Why or why not?

C. Once you assess the effectiveness of this measure, and your team feels confident that this is an appropriate measure to use, the Health Administrator of the Unit asks your team to examine the odds of patients being readmitted for those who were administered at least 3 drugs. Calculate the odds ratio and explain this finding to your administrator.