Fargen Kyle M, Neal Dan, Blackburn Spiros L, Hoh Brian L, Rahman Maryam
Department of Neurosurgery, University of Florida, Gainesville, Florida.
J Neurosurg. 2015 Apr;122(4):870-5. doi: 10.3171/2014.12.JNS14646. Epub 2015 Feb 6.
The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported quality metrics linked directly to reimbursement. The occurrence of PSIs and HACs is associated with increased mortality and hospital costs after stroke. The relationship between insurance status and PSI and HAC rates in hospitalized patients treated for acute ischemic stroke was determined using the Nationwide Inpatient Sample (NIS) database.
The NIS was queried for all hospitalizations involving acute ischemic stroke between 2002 and 2011. The rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate rates and perform multivariable analyses to determine the effects of patient variables on the probability of developing each indicator.
The NIS query revealed 1,507,336 separate patient admissions that had information on both primary payer and hospital teaching status. There were 227,676 PSIs (15.1% of admissions) and 42,841 HACs reported (2.8%). Patient safety indicators occurred more frequently in Medicaid/self-pay/no-charge patients (19.1%) and Medicare patients (15.0%) than in those with private insurance (13.6%; p < 0.0001). In a multivariable analysis, Medicaid, self-pay, or nocharge patients had significantly longer hospital stays, higher mortality, and worse outcomes than those with private insurance (p < 0.0001).
Insurance status is an independent predictor of patient safety events after stroke. Private insurance is associated with lower mortality, shorter lengths of stay, and improved clinical outcomes.
医疗保健研究与质量局患者安全指标（PSIs）和医疗保险与医疗补助服务中心医院获得性疾病（HACs）是与报销直接相关的公开报告质量指标。PSIs和HACs的发生与卒中后死亡率增加和医院成本升高相关。使用全国住院样本（NIS）数据库确定急性缺血性卒中住院患者的保险状况与PSI和HAC发生率之间的关系。
查询NIS中2002年至2011年期间所有涉及急性缺血性卒中的住院病例。通过在医院记录中搜索ICD-9编码来确定每个PSI和HAC的发生率。使用SAS统计软件包计算发生率并进行多变量分析，以确定患者变量对每个指标发生概率的影响。
NIS查询显示有1,507,336例单独的患者入院病例，这些病例既有主要付款人信息又有医院教学状况信息。报告了227,676例PSIs（占入院病例的15.1%）和42,841例HACs（占2.8%）。患者安全指标在医疗补助/自费/免费患者（19.1%）和医疗保险患者（15.0%）中比在有私人保险的患者中更频繁出现（13.6%；p<0.0001）。在多变量分析中，医疗补助、自费或免费患者的住院时间显著更长、死亡率更高且结局更差，比有私人保险的患者差（p<0.0001）。
保险状况是卒中后患者安全事件的独立预测因素。私人保险与较低的死亡率、较短的住院时间和改善的临床结局相关。
