急性心肌梗死、心力衰竭或肺炎患者住院的再入院率与死亡率之间的关系。
Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia.
机构信息
Department of Internal Medicine/Section of Cardiovascular Medicine, Yale University School of Medicine, 1 Church St, Ste 200, New Haven, CT 06510, USA.
出版信息
JAMA. 2013 Feb 13;309(6):587-93. doi: 10.1001/jama.2013.333.
IMPORTANCE
The Centers for Medicare & Medicaid Services publicly reports hospital 30-day, all-cause, risk-standardized mortality rates (RSMRs) and 30-day, all-cause, risk-standardized readmission rates (RSRRs) for acute myocardial infarction, heart failure, and pneumonia. The evaluation of hospital performance as measured by RSMRs and RSRRs has not been well characterized.
OBJECTIVE
To determine the relationship between hospital RSMRs and RSRRs overall and within subgroups defined by hospital characteristics.
DESIGN, SETTING, AND PARTICIPANTS: We studied Medicare fee-for-service beneficiaries discharged with acute myocardial infarction, heart failure, or pneumonia between July 1, 2005, and June 30, 2008 (4506 hospitals for acute myocardial infarction, 4767 hospitals for heart failure, and 4811 hospitals for pneumonia). We quantified the correlation between hospital RSMRs and RSRRs using weighted linear correlation; evaluated correlations in groups defined by hospital characteristics; and determined the proportion of hospitals with better and worse performance on both measures.
MAIN OUTCOME MEASURES
Hospital 30-day RSMRs and RSRRs.
RESULTS
Mean RSMRs and RSRRs, respectively, were 16.60% and 19.94% for acute myocardial infarction, 11.17% and 24.56% for heart failure, and 11.64% and 18.22% for pneumonia. The correlations between RSMRs and RSRRs were 0.03 (95% CI, -0.002 to 0.06) for acute myocardial infarction, -0.17 (95% CI, -0.20 to -0.14) for heart failure, and 0.002 (95% CI, -0.03 to 0.03) for pneumonia. The results were similar for subgroups defined by hospital characteristics. Although there was a significant negative linear relationship between RSMRs and RSRRs for heart failure, the shared variance between them was only 2.9% (r2 = 0.029), with the correlation most prominent for hospitals with RSMR <11%.
CONCLUSION AND RELEVANCE
Risk-standardized mortality rates and readmission rates were not associated for patients admitted with an acute myocardial infarction or pneumonia and were only weakly associated, within a certain range, for patients admitted with heart failure.
重要性
医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）公开报告了急性心肌梗死、心力衰竭和肺炎患者的 30 天全因风险标准化死亡率（RSMRs）和 30 天全因风险标准化再入院率（RSRRs）。医院的表现评估，根据 RSMRs 和 RSRRs 进行衡量，尚未得到很好的描述。
目的
确定医院 RSMRs 和 RSRRs 之间的总体关系，以及根据医院特征定义的亚组之间的关系。
设计、地点和参与者：我们研究了 2005 年 7 月 1 日至 2008 年 6 月 30 日期间接受急性心肌梗死、心力衰竭或肺炎治疗的医疗保险付费服务受益人的数据（急性心肌梗死 4506 家医院，心力衰竭 4767 家医院，肺炎 4811 家医院）。我们使用加权线性相关性来量化医院 RSMRs 和 RSRRs 之间的相关性；评估按医院特征定义的组内相关性；并确定在这两个指标上表现更好和更差的医院比例。
主要结果测量
医院 30 天 RSMRs 和 RSRRs。
结果
急性心肌梗死的平均 RSMRs 和 RSRRs 分别为 16.60%和 19.94%，心力衰竭分别为 11.17%和 24.56%，肺炎分别为 11.64%和 18.22%。RSMRs 和 RSRRs 之间的相关性分别为急性心肌梗死 0.03（95%CI，-0.002 至 0.06），心力衰竭-0.17（95%CI，-0.20 至-0.14），肺炎 0.002（95%CI，-0.03 至 0.03）。按医院特征定义的亚组结果相似。尽管心力衰竭患者的 RSMRs 和 RSRRs 之间存在显著的负线性关系，但它们之间的共享方差仅为 2.9%（r2=0.029），这种相关性在 RSMR<11%的医院中最为明显。
结论和相关性
急性心肌梗死或肺炎患者的风险标准化死亡率和再入院率之间没有相关性，心力衰竭患者的风险标准化死亡率和再入院率之间仅在一定范围内存在弱相关性。
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