心力衰竭或心肌梗死后的专业护理机构转介和医院再入院率。
Skilled nursing facility referral and hospital readmission rates after heart failure or myocardial infarction.
机构信息
Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
出版信息
Am J Med. 2012 Jan;125(1):100.e1-9. doi: 10.1016/j.amjmed.2011.06.011.
BACKGROUND
Substantial hospital-level variation in the risk of readmission after hospitalization for heart failure (HF) or acute myocardial infarction (AMI) has been reported. Prior studies have documented considerable state-level variation in rates of discharge to skilled nursing facilities (SNFs), but evaluation of hospital-level variation in SNF rates and its relationship to hospital-level readmission rates is limited.
METHODS
Hospital-level 30-day all-cause risk-standardized readmission rates (RSRRs) were calculated using claims data for fee-for-service Medicare patients hospitalized with a principal diagnosis of HF or AMI from 2006-2008. Medicare claims were used to calculate rates of discharge to SNF following HF-specific or AMI-specific admissions in hospitals with ≥25 HF or AMI patients, respectively. Weighted regression was used to quantify the relationship between RSRRs and SNF rates for each condition.
RESULTS
Mean RSRR following HF admission among 4101 hospitals was 24.7%, and mean RSRR after AMI admission among 2453 hospitals was 19.9%. Hospital-level SNF rates ranged from 0% to 83.8% for HF and from 0% to 77.8% for AMI. No significant relationship between RSRR after HF and SNF rate was found in adjusted regression models (P=.15). RSRR after AMI increased by 0.03 percentage point for each 1 absolute percentage point increase in SNF rate in adjusted regression models (P=.001). Overall, HF and AMI SNF rates explained <1% and 4% of the variation for their respective RSRRs.
CONCLUSION
SNF rates after HF or AMI hospitalization vary considerably across hospitals, but explain little of the variation in 30-day all-cause readmission rates for these conditions.
背景
据报道，心力衰竭（HF）或急性心肌梗死（AMI）住院患者再入院的风险在医院间存在较大差异。先前的研究已经记录了在熟练护理设施（SNF）出院率方面存在相当大的州级差异，但对 SNF 率的医院间差异及其与医院间再入院率的关系的评估有限。
方法
使用 2006-2008 年 Medicare 按服务收费患者住院治疗 HF 或 AMI 的主要诊断的索赔数据，计算 30 天全因风险标准化再入院率（RSRR）。在 HF 或 AMI 患者分别≥25 例的医院中，使用 Medicare 索赔来计算 HF 特定或 AMI 特定入院后转入 SNF 的比例。使用加权回归来量化两种情况下 RSRR 与 SNF 率之间的关系。
结果
4101 家医院 HF 入院后的平均 RSRR 为 24.7%，2453 家医院 AMI 入院后的平均 RSRR 为 19.9%。HF 的医院间 SNF 率范围为 0%至 83.8%，AMI 的医院间 SNF 率范围为 0%至 77.8%。在调整后的回归模型中，HF 后 RSRR 与 SNF 率之间无显著关系（P=.15）。在调整后的回归模型中，SNF 率每增加 1 个百分点，AMI 后 RSRR 增加 0.03 个百分点（P=.001）。总体而言，HF 和 AMI 的 SNF 率解释了这两种情况各自的 30 天全因再入院率差异的<1%和 4%。
结论
HF 或 AMI 住院后 SNF 率在医院间差异较大，但对这两种情况的 30 天全因再入院率的差异解释有限。
Zotero 插件