Weill Cornell Medical College, New York, NY, USA.
Health Aff (Millwood). 2013 Jun;32(6):1083-91. doi: 10.1377/hlthaff.2012.0518.
Recent national policies use risk-standardized readmission rates to measure hospital performance on the theory that readmissions reflect dimensions of the quality of patient care that are influenced by hospitals. In this article our objective was to assess readmission rates as a hospital quality measure. First we compared quartile rankings of hospitals based on readmission rates in 2009 and 2011 to see whether hospitals maintained their relative performance or whether shifts occurred that suggested either changes in quality or random variation. Next we examined the relationship between readmission rates and several commonly used hospital quality indicators, including risk-standardized mortality rates, volume, teaching status, and process-measure performance. We found that quartile rankings fluctuated and that readmission rates for lower-performing hospitals in 2009 tended to improve by 2011, while readmission rates for higher-performing hospitals tended to worsen. Regression to the mean (a form of statistical noise) accounted for a portion of the changes in hospital performance. We also found that readmission rates were higher in teaching hospitals and were weakly correlated with the other indicators of hospital quality. Policy makers should consider augmenting the use of readmission rates with other measures of hospital performance during care transitions and should build on current efforts that take a communitywide approach to the readmissions issue.
最近的国家政策使用风险标准化再入院率来衡量医院在患者护理质量方面的表现，理论上认为再入院反映了受医院影响的护理质量维度。本文旨在评估再入院率作为医院质量衡量标准的作用。首先，我们比较了 2009 年和 2011 年再入院率的医院四分位排名，以了解医院是否保持了相对绩效，或者是否出现了表明质量变化或随机波动的变化。接下来，我们研究了再入院率与几种常用的医院质量指标之间的关系，包括风险标准化死亡率、容量、教学地位和流程测量表现。我们发现，四分位排名波动较大，2009 年表现较差的医院的再入院率在 2011 年有所改善，而表现较好的医院的再入院率则有所恶化。回归均值（一种统计噪声形式）解释了医院绩效变化的一部分原因。我们还发现，教学医院的再入院率较高，与其他医院质量指标的相关性较弱。政策制定者在医疗过渡期应考虑使用其他医院绩效衡量标准来补充再入院率，并且应在当前采取社区范围方法解决再入院问题的基础上再接再厉。
