Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
J Hosp Med. 2011 Mar;6(3):142-50. doi: 10.1002/jhm.890. Epub 2011 Jan 5.
Readmission following hospital discharge has become an important target of quality improvement.
To describe the development, validation, and results of a risk-standardized measure of hospital readmission rates among elderly patients with pneumonia employed in federal quality measurement and efficiency initiatives.
A retrospective cohort study using hospital and outpatient Medicare claims from 2005 and 2006.
A total of 4675 hospitals in the United States.
Medicare beneficiaries aged >65 years with a principal discharge diagnosis of pneumonia.
None.
Hospital-specific, risk-standardized 30-day readmission rates calculated as the ratio of predicted-to-expected readmissions, multiplied by the national unadjusted rate. Comparison of the areas under the receiver operating curve (ROC) and measurement of correlation coefficient in development and validation samples.
The development sample consisted of 226,545 hospitalizations at 4675 hospitals, with an overall unadjusted 30-day readmission rate of 17.4%. The median risk-standardized hospital readmission rate was 17.3%, and the odds of readmission for a hospital one standard deviation above average was 1.4 times that of a hospital one standard deviation below average. Performance of the medical record and administrative models was similar (areas under the ROC curve 0.59 and 0.63, respectively) and the correlation coefficient of estimated state-specific standardized readmission rates from the administrative and medical record models was 0.96.
Rehospitalization within 30 days of treatment for pneumonia is common, and rates vary across hospitals. A risk-standardized measure of hospital readmission rates derived from administrative claims has similar performance characteristics to one based on medical record review.
医院出院后的再入院已成为质量改进的重要目标。
描述一种用于联邦质量测量和效率计划的老年肺炎患者医院再入院率的风险标准化测量方法的开发、验证和结果。
使用 2005 年和 2006 年的医院和门诊 Medicare 索赔进行回顾性队列研究。
美国共有 4675 家医院。
年龄>65 岁的 Medicare 受益人，主要出院诊断为肺炎。
无。
计算为预测与实际再入院率之比，乘以全国未经调整的比率的医院特定、风险标准化的 30 天再入院率。开发和验证样本中接收者操作特征曲线（ROC）下面积的比较和相关系数的测量。
开发样本包括来自 4675 家医院的 226545 例住院治疗，总体未经调整的 30 天再入院率为 17.4%。中位数风险标准化医院再入院率为 17.3%，医院平均水平以上一个标准差的再入院率是医院平均水平以下一个标准差的 1.4 倍。病历和行政模型的性能相似（ROC 曲线下面积分别为 0.59 和 0.63），行政和病历模型估计的特定州标准化再入院率的相关系数为 0.96。
肺炎治疗后 30 天内再次住院很常见，且医院之间的比率存在差异。一种基于行政索赔的医院再入院率的风险标准化测量方法具有与基于病历审查的方法相似的性能特征。
