医疗保险按服务项目付费患者的急性心肌梗死再入院情况：一项探索30天再入院因素的州级分析。
Acute myocardial infarction rehospitalization of the medicare fee-for-service patient: a state-level analysis exploring 30-day readmission factors.
作者信息
Schmeida Mary, Savrin Ronald
机构信息
Mary Schmeida, PhD, is an expert in public health policy who has served in several key research positions and is also affiliated with Kent State University. Her research in health care and welfare policy has been published and presented nationally and internationally. Ronald Savrin, MD, MBA, is an internationally recognized Vascular Surgeon who has served as Professor of surgery and has held numerous administrative, educational, and corporate appointments. He has led state and national quality improvement programs and is actively engaged in nationwide efforts to improve the medical care delivery system.
出版信息
Prof Case Manag. 2013 Nov-Dec;18(6):295-302. doi: 10.1097/NCM.0b013e3182a08425.
PURPOSE OF THE STUDY
Acute myocardial infarction (AMI) readmission among the older adults is frequent and costly to the Medicare Trust Fund and to the patient in preventable suffering. In this study, we explore factors that are associated with states having AMI readmission rates that are higher than the U.S. national rate.
PRIMARY PRACTICE SETTING(S): Acute inpatient hospital settings.
METHODOLOGY AND SAMPLE
Multivariate regression analysis of 50 state-level data is used. The dependent variable AMI 30-day readmission worse than U.S. rate is based on adult Medicare fee-for-service patients hospitalized with a primary discharge diagnosis of AMI and for which a subsequent all-cause readmission occurred within 30 days of their last discharge.
RESULTS
We find one key variable--states with more β-blocker prescription given at discharge--that is significantly associated with a decrease in probability in states ranking "worse" on AMI 30-day readmission. Whereas, states with more total days of care per 1,000 Medicare enrollees, more community hospital outpatient visits per 1,000 population, and greater aspirin prescription given at discharge have a greater probability for AMI 30-day readmission to be "worse" than the U.S. national rate.
IMPLICATIONS FOR CASE MANAGEMENT PRACTICE
Case management programs targeting efficient medication reconciliation from the hospital setting to the transfer setting can potentially help minimize readmission for patients highly dependent on β-blockers for improved clinical outcomes. This intervention may be more effective than other factors to improve state-level hospital status on AMI 30-day readmission. Factors such as total days of care per 1,000 Medicare enrollees, more community hospital outpatient visits per 1,000 populations, and greater aspirin prescription given at discharge may not be as important as β-blocker prescription given at discharge.
研究目的
老年急性心肌梗死（AMI）患者再次入院情况频繁发生，这对医疗保险信托基金以及患者而言成本高昂，还会带来可避免的痛苦。在本研究中，我们探究了与AMI再次入院率高于美国全国水平的州相关的因素。
主要实践环境
急性住院医院环境。
方法与样本
采用对50个州级数据的多变量回归分析。因变量“AMI 30天再次入院情况比美国水平更差”基于以AMI为主要出院诊断住院的成年医疗保险按服务收费患者，且在其上次出院后30天内发生了随后的全因再次入院情况。
结果
我们发现一个关键变量——出院时给予更多β受体阻滞剂处方的州——与AMI 30天再次入院情况排名“更差”的州概率降低显著相关。然而，每1000名医疗保险参保者护理总天数更多、每1000人口社区医院门诊就诊次数更多以及出院时给予更多阿司匹林处方的州，其AMI 30天再次入院情况“比美国全国水平更差”的概率更高。
对病例管理实践的启示
针对从医院环境到转诊环境进行高效药物核对的病例管理项目，可能有助于最大限度减少高度依赖β受体阻滞剂以改善临床结局的患者再次入院情况。这种干预措施可能比其他因素在改善州级医院AMI 30天再次入院情况方面更有效。每1000名医疗保险参保者护理总天数、每1000人口社区医院门诊就诊次数更多以及出院时给予更多阿司匹林处方等因素，可能不如出院时给予β受体阻滞剂处方重要。
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