比较评估 30 天再入院率的 2 种方法：对退伍军人健康管理局的医院档案管理有何影响？

Comparing 2 methods of assessing 30-day readmissions: what is the impact on hospital profiling in the veterans health administration?

机构信息

Center for Organization, Leadership, and Management Research (COLMR), VA Boston Healthcare System, Boston, MA, USA.

出版信息

Med Care. 2013 Jul;51(7):589-96. doi: 10.1097/MLR.0b013e31829019a4.

DOI:10.1097/MLR.0b013e31829019a4

PMID:23604016

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4557787/

Abstract

BACKGROUND

The Centers for Medicare and Medicaid Services' (CMS) all-cause readmission measure and the 3M Health Information System Division Potentially Preventable Readmissions (PPR) measure are both used for public reporting. These 2 methods have not been directly compared in terms of how they identify high-performing and low-performing hospitals.

OBJECTIVES

To examine how consistently the CMS and PPR methods identify performance outliers, and explore how the PPR preventability component impacts hospital readmission rates, public reporting on CMS' Hospital Compare website, and pay-for-performance under CMS' Hospital Readmission Reduction Program for 3 conditions (acute myocardial infarction, heart failure, and pneumonia).

METHODS

We applied the CMS all-cause model and the PPR software to VA administrative data to calculate 30-day observed FY08-10 VA hospital readmission rates and hospital profiles. We then tested the effect of preventability on hospital readmission rates and outlier identification for reporting and pay-for-performance by replacing the dependent variable in the CMS all-cause model (Yes/No readmission) with the dichotomous PPR outcome (Yes/No preventable readmission).

RESULTS

The CMS and PPR methods had moderate correlations in readmission rates for each condition. After controlling for all methodological differences but preventability, correlations increased to >90%. The assessment of preventability yielded different outlier results for public reporting in 7% of hospitals; for 30% of hospitals there would be an impact on Hospital Readmission Reduction Program reimbursement rates.

CONCLUSIONS

Despite uncertainty over which readmission measure is superior in evaluating hospital performance, we confirmed that there are differences in CMS-generated and PPR-generated hospital profiles for reporting and pay-for-performance, because of methodological differences and the PPR's preventability component.

摘要

背景

医疗保险和医疗补助服务中心（CMS）的全因再入院指标和 3M 健康信息系统部门可预防再入院（PPR）指标均用于公共报告。这两种方法在识别表现优异和表现不佳的医院方面尚未进行直接比较。

目的

研究 CMS 和 PPR 方法在识别绩效异常值方面的一致性，并探讨 PPR 的可预防性成分如何影响医院的再入院率、CMS 的 Hospital Compare 网站上的公共报告以及 CMS 的 Hospital Readmission Reduction Program 对 3 种疾病（急性心肌梗死、心力衰竭和肺炎）的支付绩效。

方法

我们应用 CMS 的全因模型和 PPR 软件对 VA 管理数据进行分析，以计算 30 天观察到的 FY08-10VA 医院再入院率和医院概况。然后，我们通过将 CMS 全因模型中的因变量（是否再入院）替换为二分类 PPR 结果（是否可预防再入院），测试了可预防性对医院再入院率和报告及支付绩效异常值识别的影响。

结果

CMS 和 PPR 方法在每种疾病的再入院率方面具有中等相关性。在控制了所有方法差异但可预防性差异后，相关性增加到>90%。可预防性评估对 7%的医院的公共报告产生了不同的异常值结果；对 30%的医院，Hospital Readmission Reduction Program 报销率将会受到影响。