Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
J Orthop Trauma. 2011 Nov;25(11):666-9. doi: 10.1097/BOT.0b013e31821146b1.
Hospitals and providers that accept transfer patients risk lower ratings on publically reported quality measures that are inadequately adjusted for infirmity and complexity. We compared the outcomes of transferred patients and nontransferred patients after treatment of a hip fracture and sought to determine if expected outcomes based on an expansion of All Patient Refined-Diagnosis Related Groups (APR-DRGs) norms are accurately adjusted for transfer status.
Retrospective cohort study.
Tertiary care referral center.
Four hundred six consecutive patients 65 years and older who received operative treatment of an acute hip fracture.
Patients who were transferred from another acute care hospital or a skilled nursing facility before treatment were classified as transfer patients (n = 123), and all other patients were nontransfer patients (n = 283).
Groups were compared with respect to in-hospital mortality, length of stay (LOS), excess days over the geometric mean length of stay (GMLOS), and readmission rate as well as expected length of stay (Exp LOS) and expected mortality (Exp Mort) based on APR-DRG norms and additional adjustment for transfer status.
Transfer patients had significantly greater LOS (10.2 vs 9.6 days; P < 0.05), Exp LOS (9.7 vs 7.7 days; P < 0.001), Exp Mort (0.07 vs 0.03; P = 0.004), and excess days over the GMLOS (4.1 vs 3.3 days; P = 0.025) than nontransfer patients, near-significant greater in-hospital mortality (9.8 vs 4.9%; P = 0.069), and similar readmission rates. The differences in LOS and Exp LOS were nonsignificant in both transfer (P = 0.49) and nontransfer patients (P = 0.10).
Patients 65 years and older transferred to a tertiary care facility for treatment of an acute hip fracture have worse outcome than nontransfer patients. Unadjusted data such as in-hospital mortality may be misleading, but risk adjustment using the APR-DRG methodology and additional correction for transfer status may provide meaningful benchmarks.
接收转诊患者的医院和医疗服务提供者在上报的质量指标上的评分可能较低，因为这些指标对患者的虚弱程度和病情复杂性的调整不足。我们比较了接受髋关节骨折治疗的转诊患者和非转诊患者的结局，并试图确定是否可以根据 All Patient Refined-Diagnosis Related Groups（APR-DRGs）规范的扩展来准确调整转诊状态的预期结果。
回顾性队列研究。
三级转诊中心。
406 例连续接受手术治疗的急性髋部骨折且年龄在 65 岁及以上的患者。
在治疗前从另一家急性护理医院或熟练护理机构转来的患者被归类为转诊患者（n=123），所有其他患者均为非转诊患者（n=283）。
比较两组患者的院内死亡率、住院时间（LOS）、超过几何均数 LOS 的天数（GMLOS）、再入院率，以及基于 APR-DRG 规范和额外调整转诊状态后的预期住院时间（Exp LOS）和预期死亡率（Exp Mort）。
转诊患者的 LOS（10.2 天比 9.6 天；P<0.05）、Exp LOS（9.7 天比 7.7 天；P<0.001）、Exp Mort（0.07 比 0.03；P=0.004）和超过 GMLOS 的天数（4.1 天比 3.3 天；P=0.025）均显著大于非转诊患者，院内死亡率也接近显著升高（9.8%比 4.9%；P=0.069），但再入院率相似。在转诊（P=0.49）和非转诊患者（P=0.10）中，LOS 和 Exp LOS 的差异均无统计学意义。
转至三级护理机构接受急性髋部骨折治疗的 65 岁及以上患者的结局较非转诊患者差。未经调整的数据（如院内死亡率）可能具有误导性，但使用 APR-DRG 方法学和额外的转诊状态校正进行风险调整可能提供有意义的基准。
