发表的熟练护理设施质量评级与医疗保险心力衰竭受益人的结果之间的关联。
Associations between published quality ratings of skilled nursing facilities and outcomes of medicare beneficiaries with heart failure.
机构信息
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
出版信息
J Am Med Dir Assoc. 2012 Feb;13(2):188.e1-6. doi: 10.1016/j.jamda.2011.04.020. Epub 2011 May 31.
INTRODUCTION
Nursing Home Compare quality ratings are designed to allow patients, families, and clinicians to compare facilities based on quality, but associations of the current measures with important clinical outcomes are not known. Our study examined associations between ratings and readmission and mortality among Medicare beneficiaries admitted to a skilled nursing facility with a primary diagnosis of heart failure.
METHODS
We conducted a retrospective cohort study of 164,672 Medicare beneficiaries discharged to skilled nursing facilities after hospitalization for heart failure in 2006-2007. The main outcome measures were readmission and mortality within 90 days.
RESULTS
One-fifth of the 13,619 skilled nursing facilities received a 1-star rating and 11% received a 5-star rating. Nearly half of the patients discharged to a skilled nursing facility were readmitted to a hospital within 90 days after discharge, and 30% died within 90 days. Compared with patients in 5-star skilled nursing facilities, patients in 1-star facilities had higher risks of 90-day readmission (hazard ratio, 1.08) and mortality (1.15). After adjustment for facility size and ownership type, the associations between the quality rating and readmission were not statistically significant, but the associations with mortality were significant.
CONCLUSION
Publicly reported Nursing Home Compare quality ratings of Medicare-certified skilled nursing facilities were modestly associated with 90-day readmission and mortality among Medicare beneficiaries discharged to these facilities after hospitalization for heart failure.
简介
养老院比较（Nursing Home Compare）质量评级旨在让患者、家属和临床医生能够根据质量来比较设施，但目前这些措施与重要临床结果的关联尚不清楚。我们的研究调查了评级与 Medicare 受益人在因心力衰竭住院后入住疗养院的再入院和死亡率之间的关系，这些受益人被诊断为心力衰竭，并被送往疗养院接受康复治疗。
方法
我们对 2006 年至 2007 年因心力衰竭住院后被送往疗养院康复治疗的 164672 名 Medicare 受益人的回顾性队列进行了研究。主要观察指标为 90 天内的再入院和死亡率。
结果
在接受调查的 13619 家疗养院中，有 1/5 被评为 1 星级，11%被评为 5 星级。近一半出院到疗养院的患者在出院后 90 天内再次住院，30%在 90 天内死亡。与 5 星级疗养院的患者相比，1 星级疗养院的患者在 90 天内再入院的风险更高（风险比为 1.08），死亡率也更高（1.15）。在调整设施规模和所有权类型后，质量评级与再入院之间的关联不再具有统计学意义，但与死亡率之间的关联仍然显著。
结论
在 Medicare 认证的疗养院中，公开报告的养老院比较质量评级与心力衰竭住院后入住这些疗养院的 Medicare 受益人的 90 天再入院和死亡率之间存在适度关联。
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