Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA, USA.
Med Care. 2013 Jan;51(1):13-9. doi: 10.1097/MLR.0b013e31825c2fec.
Scrutiny of hospital readmissions has led to the development and implementation of policies targeted at reducing readmission rates.
To assess whether historic hospital readmission rates predict risk-adjusted patient readmission and to measure the costs of readmission, thus informing reimbursement policies under consideration by non-Veterans Health Administration payers.
DESIGN, SETTINGS, AND PARTICIPANTS: Multivariable hospital-fixed effects regression analyses of patients admitted to 129 Veterans Health Administration hospitals between 2005 and 2009 for 3 common conditions, acute myocardial infarction (AMI), community-acquired pneumonia (CAP), and congestive heart failure (CHF).
We examined whether previous hospital readmission rates predicted risk-adjusted readmission or 30-day episode cost of care for subsequent patients. We then examined the 30-day inpatient hospitalization episode cost differences between those who had a readmission in the episode and those who did not.
Hospital readmission rates in the previous quarter are not predictive of individual patient risk-adjusted readmission or of patients' inpatient hospitalization episode cost in the subsequent quarter. Relative to those who were not readmitted within 30 days of index visit discharge, readmitted patients had 30-day episode costs that were 53.3% (P<0.001), 82.8% (P<0.001), and 79.8% (P<0.001) higher for AMI, CAP, and CHF hospitalization episodes, respectively.
Previous hospital readmission rates are poor predictors of readmission for future individual patients, therefore, policies using these measures to guide subsequent reimbursement are problematic for hospitals that are financially constrained. Our findings indicate current diagnosis related group payments would need to be raised by 10.0% for AMI, 11.5% for CAP, and 16.6% for CHF if these are to become 30-day bundled payments.
对医院再入院率的审查导致了旨在降低再入院率的政策的制定和实施。
评估既往医院再入院率是否预测风险调整后患者再入院率，并衡量再入院的成本，从而为非退伍军人健康管理局支付者正在考虑的报销政策提供信息。
设计、地点和参与者：对 2005 年至 2009 年间在 129 家退伍军人健康管理局医院因 3 种常见疾病（急性心肌梗死[AMI]、社区获得性肺炎[CAP]和充血性心力衰竭[CHF]）入院的患者进行了多变量医院固定效应回归分析。
我们研究了前一个季度的医院再入院率是否预测了风险调整后的再入院率或随后患者的 30 天发病成本。然后，我们研究了在该发病期内再入院的患者和未再入院的患者之间的 30 天住院治疗发病成本差异。
前一个季度的医院再入院率与个体患者风险调整后的再入院率或患者在下一个季度的住院治疗发病成本无关。与在指数就诊出院后 30 天内未再入院的患者相比，再入院患者的 30 天发病成本分别高出 53.3%（P<0.001）、82.8%（P<0.001）和 79.8%（P<0.001），用于 AMI、CAP 和 CHF 住院治疗。
既往医院再入院率是未来个体患者再入院的不良预测指标，因此，使用这些措施来指导后续报销的政策对财务受限的医院来说存在问题。我们的研究结果表明，如果这些要成为 30 天捆绑支付，那么当前的诊断相关组支付需要分别提高 AMI 10.0%、CAP 11.5%和 CHF 16.6%。
