临床和社会风险因素对卒中再入院医院特征的影响：一项队列研究。

Effect of clinical and social risk factors on hospital profiling for stroke readmission: a cohort study.

出版信息

Ann Intern Med. 2014 Dec 2;161(11):775-84. doi: 10.7326/M14-0361.

Abstract

BACKGROUND

The Centers for Medicare & Medicaid Services (CMS) and Veterans Health Administration (VA) will report 30-day stroke readmission rates as a measure of hospital quality. A national debate on whether social risk factors should be included in models developed for hospital profiling is ongoing.

OBJECTIVE

To compare a CMS-based model of 30-day readmission with a more comprehensive model that includes measures of social risk (such as homelessness) or clinical factors (such as stroke severity and functional status).

DESIGN

Data from a retrospective cohort study were used to develop a CMS-based 30-day readmission model that included age and comorbid conditions based on codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (model 1). This model was then compared with one that included administrative social risk factors (model 2). Finally, the CMS model (model 1) was compared with a model that included social risk and clinical factors from chart review (model 3). These 3 models were used to rank hospitals by 30-day risk-standardized readmission rates and examine facility rankings among the models.

SETTING

Hospitals in the VA.

PARTICIPANTS

Patients hospitalized with stroke in 2007.

MEASUREMENTS

30-day readmission rates.

RESULTS

The 30-day readmission rate was 12.8%. The c-statistics for the 3 models were 0.636, 0.646, and 0.661, respectively. All hospitals were classified as performing "as expected" using all 3 models (that is, performance did not differ from the VA national average); therefore, the addition of detailed clinical information or social risk factors did not alter assessment of facility performance.

LIMITATION

A predominantly male veteran cohort limits the generalizability of these findings.

CONCLUSION

In the VA, more comprehensive models that included social risk and clinical factors did not affect hospital comparisons based on 30-day readmission rates.

PRIMARY FUNDING SOURCE

U.S. Department of Veterans Affairs.

摘要

背景

医疗保险和医疗补助服务中心（CMS）和退伍军人事务部（VA）将报告 30 天内中风再入院率，作为医院质量的衡量标准。关于是否应将社会风险因素纳入医院概况模型的全国性辩论正在进行中。

目的

比较基于 CMS 的 30 天再入院模型和更全面的模型，该模型包括社会风险（如无家可归）或临床因素（如中风严重程度和功能状态）的测量值。

设计

使用回顾性队列研究的数据，开发了一个基于 CMS 的 30 天再入院模型，该模型基于国际疾病分类第 9 版临床修订版（模型 1）中的代码包含年龄和合并症。然后将该模型与包含行政社会风险因素的模型（模型 2）进行比较。最后，将 CMS 模型（模型 1）与从图表审查中包含社会风险和临床因素的模型（模型 3）进行比较。这 3 个模型用于按 30 天风险标准化再入院率对医院进行排名，并检查模型之间的设施排名。