减少住院时间是否会增加医疗保险按服务收费受益人的再住院率？
Does reducing length of stay increase rehospitalization of medicare fee-for-service beneficiaries discharged to skilled nursing facilities?
机构信息
Center for Healthcare Informatics and Policy, Weill Medical College, Cornell University, New York, New York; Department of Public Health, Weill Cornell Medical College, New York, New York.
出版信息
J Am Geriatr Soc. 2013 Sep;61(9):1443-8. doi: 10.1111/jgs.12411. Epub 2013 Aug 8.
OBJECTIVES
To analyze the relationship between length of stay and rehospitalization.
DESIGN
Retrospective cohort study.
SETTING
Six thousand five hundred thirty-seven hospitals nationwide from January 1999 through September 2005.
PARTICIPANTS
Medicare fee-for-service beneficiaries associated with 2,101,481 hospitalizations.
MEASUREMENTS
Thirty-day rehospitalization derived from Medicare hospital claims using the implementation of Medicare's post-acute care transfer policy as a quasi-experiment.
RESULTS
Medicare's post-acute care transfer policy led to immediate declines in length of stay. A 1-day decrease in length of stay was associated with an absolute increase in 30-day rehospitalization of 1.56 percentage points (95% confidence interval (CI) = 0.30-2.82) for acute myocardial infarction (AMI) with major complications and 0.81 percentage points (95% CI = 0.03-1.60) for kidney infection or urinary tract infection (UTI) without major complications. Individuals hospitalized for AMI without major complications, heart failure, or kidney infection or UTI with major complications had no increase in 30-day rehospitalization.
CONCLUSION
A 1-day reduction in hospital length of stay was not consistently associated with a higher rate of rehospitalization.
目的
分析住院时间与再入院之间的关系。
设计
回顾性队列研究。
地点
1999 年 1 月至 2005 年 9 月，全国范围内的 6537 家医院。
参与者
与 2101481 例住院治疗相关的 Medicare 按服务收费受益人的数据。
测量方法
使用 Medicare 后期护理转移政策的实施作为准实验，从 Medicare 医院索赔中得出 30 天再入院率。
结果
Medicare 的后期护理转移政策导致住院时间立即缩短。急性心肌梗死（AMI）合并主要并发症时，住院时间每减少 1 天，30 天再入院率绝对增加 1.56 个百分点（95%置信区间（CI）=0.30-2.82），无主要并发症的肾脏感染或尿路感染（UTI）时增加 0.81 个百分点（95% CI=0.03-1.60）。无主要并发症的 AMI、心力衰竭或肾脏感染或 UTI 住院患者，30 天再入院率没有增加。
结论
住院时间减少 1 天并不总是与再入院率的增加相关。
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