*Center for Healthcare Organization and Implementation Research (CHOIR) †Department of Surgery, Boston University School of Medicine ‡Department of Operations and Technology Management, Boston University School of Management §Department of Surgery, Brigham and Women's Hospital, Boston ∥Center for Healthcare Organization and Implementation Research (CHOIR), Bedford ¶Section of General Internal Medicine, Boston University School of Medicine #Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
Med Care. 2014 Mar;52(3):243-9. doi: 10.1097/MLR.0000000000000081.
Readmissions are an attractive quality measure because they offer a broad view of quality beyond the index hospitalization. However, the extent to which medical or surgical readmissions reflect quality of care is largely unknown, because of the complexity of factors related to readmission. Identifying those readmissions that are clinically related to the index hospitalization is an important first step in closing this knowledge gap.
The aims of this study were to examine unplanned readmissions in the Veterans Health Administration, identify clinically related versus unrelated unplanned readmissions, and compare the leading reasons for unplanned readmission between medical and surgical discharges.
We classified 2,069,804 Veterans Health Administration hospital discharges (Fiscal Years 2003-2007) into medical/surgical index discharges with/without readmissions per their diagnosis-related groups. Our outcome variable was "all-cause" 30-day unplanned readmission. We compared medical and surgical unplanned readmissions (n=217,767) on demographics, clinical characteristics, and readmission reasons using descriptive statistics.
Among all unplanned readmissions, 41.5% were identified as clinically related. Not surprisingly, heart failure (10.2%) and chronic obstructive pulmonary disease (6.5%) were the top 2 reasons for clinically related readmissions among medical discharges; postoperative complications (ie, complications of surgical procedures and medical care or complications of devices) accounted for 70.5% of clinically related readmissions among surgical discharges.
Although almost 42% of unplanned readmissions were identified as clinically related, the majority of unplanned readmissions were unrelated to the index hospitalization. Quality improvement interventions targeted at processes of care associated with the index hospitalization are likely to be most effective in reducing clinically related readmissions. It is less clear how to reduce nonclinically related readmissions; these may involve broader factors than inpatient care.
再入院是一种有吸引力的质量衡量标准，因为它提供了超越索引住院的广泛质量视角。然而，由于与再入院相关的因素复杂，医疗或手术再入院在多大程度上反映了护理质量在很大程度上仍是未知的。确定与索引住院相关的再入院是缩小这一知识差距的重要第一步。
本研究旨在检查退伍军人健康管理局（Veterans Health Administration，VHA）的非计划性再入院情况，确定临床相关和不相关的非计划性再入院，并比较医疗和手术出院患者的非计划性再入院的主要原因。
我们根据其诊断相关组（diagnosis-related groups，DRGs），将 2069804 例退伍军人健康管理局（Veterans Health Administration，VHA）住院患者（2003-2007 财政年度）分为有/无再入院的医疗/手术索引出院。我们的结局变量是“全因”30 天非计划性再入院。我们使用描述性统计方法比较了医疗和手术非计划性再入院（n=217767）的人口统计学、临床特征和再入院原因。
在所有非计划性再入院中，41.5%被确定为临床相关。不出所料，心力衰竭（10.2%）和慢性阻塞性肺疾病（6.5%）是医疗出院患者中临床相关再入院的前 2 大原因；手术出院患者中，术后并发症（即手术和医疗护理并发症或器械并发症）占临床相关再入院的 70.5%。
尽管近 42%的非计划性再入院被确定为临床相关，但大多数非计划性再入院与索引住院无关。针对与索引住院相关的护理过程的质量改进干预措施可能最有效地降低临床相关的再入院率。如何降低非临床相关的再入院率尚不清楚；这些可能涉及比住院护理更广泛的因素。
