DuBard C Annette, Jacobson Vann Julie C, Jackson Carlos T
1 Community Care of North Carolina , Raleigh, North Carolina.
2 American Institutes for Research , Chapel Hill, North Carolina.
Popul Health Manag. 2015 Oct;18(5):351-7. doi: 10.1089/pop.2014.0138. Epub 2015 Jan 21.
The 30-day readmission rate is a common performance indicator for hospitals and accountable care entities. There is reason to question whether measuring readmissions as a function of hospital discharges is an appropriate measure of performance for initiatives that aim to improve overall cost and quality outcomes in a population. The objectives of this study were to compare trends in 30-day readmission rates per discharge to population-based measures of hospital admission and readmission frequency in a high-risk statewide Medicaid population over a 5-year period of quality improvement and care management intervention. Further, this study aimed to examine case-mix changes among hospitalized beneficiaries over time. This was a retrospective analysis of North Carolina Medicaid paid claims 2008 through 2012 for beneficiaries with multiple chronic or catastrophic conditions. Thirty-day readmission rates per discharge trended upward from 18.3% in 2008 to 18.7% in 2012. However, the rate of 30-day readmissions per 1000 beneficiaries declined from 123.3 to 110.7. Overall inpatient admissions per 1000 beneficiaries decreased from 579.4 to 518.5. The clinical complexity of hospitalized patients increased over the 5-year period. Although rates of hospital admissions and readmissions fell substantially in this high-risk population over 5 years, the 30-day readmission rate trend appeared unfavorable when measured as a percent of hospital discharges. This may be explained by more complex patients requiring hospitalization over time. The choice of metrics significantly affects the perceived effectiveness of improvement initiatives. Emphasis on readmission rates per discharge may be misguided for entities with a population health management focus.
30天再入院率是医院和责任医疗实体常用的绩效指标。有理由质疑，将再入院情况作为医院出院情况的一项功能来衡量，对于旨在改善总体成本和人群质量结果的举措而言，是否是一种恰当的绩效衡量标准。本研究的目的是在为期5年的质量改进和护理管理干预期间，比较高危全州医疗补助人群中每次出院的30天再入院率趋势与基于人群的医院入院和再入院频率衡量指标。此外，本研究旨在考察随时间推移住院受益人的病例组合变化。这是一项对2008年至2012年北卡罗来纳州医疗补助支付索赔的回顾性分析，针对患有多种慢性或灾难性疾病的受益人。每次出院的30天再入院率从2008年的18.3%呈上升趋势至了2012年的18.7%。然而，每1000名受益人的30天再入院率从123.3降至了110.7。每1000名受益人的总体住院入院率从579.4降至了518.5。在这5年期间，住院患者的临床复杂性增加了。尽管在5年时间里，这一高危人群的医院入院率和再入院率大幅下降，但以医院出院人数的百分比来衡量时，30天再入院率趋势似乎并不乐观。这可能是由于随着时间推移，需要住院治疗的患者病情更为复杂。指标的选择会显著影响对改进举措有效性的认知。对于关注人群健康管理的实体而言，强调每次出院的再入院率可能会产生误导。
