Wasfy Jason H, Yeh Robert W
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W.) and The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.).
Circ Cardiovasc Qual Outcomes. 2016 Mar;9(2):186-9. doi: 10.1161/CIRCOUTCOMES.115.002472. Epub 2016 Jan 26.
Between 2013 and 2014, the Centers for Medicare and Medicaid Services and the National Cardiovascular Data Registry publically reported risk-adjusted 30-day readmission rates after percutaneous coronary intervention (PCI) as a pilot project. A key strength of this public reporting effort included risk adjustment with clinical rather than administrative data. Furthermore, because readmission after PCI is common, expensive, and preventable, this metric has substantial potential to improve quality and value in American cardiology care. Despite this, concerns about the metric exist. For example, few PCI readmissions are caused by procedural complications, limiting the extent to which improved procedural technique can reduce readmissions. Also, similar to other readmission measures, PCI readmission is associated with socioeconomic status and race. Accordingly, the metric may unfairly penalize hospitals that care for underserved patients. Perhaps in the context of these limitations, Centers for Medicare and Medicaid Services has not yet included PCI readmission among metrics that determine Medicare financial penalties. Nevertheless, provider organizations may still wish to focus on this metric to improve value for cardiology patients. PCI readmission is associated with low-risk chest discomfort and patient anxiety. Therefore, patient education, improved triage mechanisms, and improved care coordination offer opportunities to minimize PCI readmissions. Because PCI readmission is common and costly, reducing PCI readmission offers provider organizations a compelling target to improve the quality of care, and also performance in contracts involve shared financial risk.
2013年至2014年期间，医疗保险和医疗补助服务中心以及国家心血管数据注册中心公开报告了经皮冠状动脉介入治疗（PCI）后经过风险调整的30天再入院率，作为一个试点项目。这项公开报告工作的一个关键优势在于使用临床数据而非行政数据进行风险调整。此外，由于PCI后的再入院情况很常见、成本高昂且可预防，这一指标在改善美国心脏病护理的质量和价值方面具有巨大潜力。尽管如此，对该指标仍存在担忧。例如，很少有PCI再入院是由手术并发症引起的，这限制了改进手术技术可降低再入院率的程度。此外，与其他再入院衡量指标类似，PCI再入院与社会经济地位和种族有关。因此，该指标可能会不公平地惩罚那些为服务不足患者提供护理的医院。或许正是在这些限制的背景下，医疗保险和医疗补助服务中心尚未将PCI再入院纳入决定医疗保险财务处罚的指标之中。尽管如此，医疗服务提供机构可能仍希望关注这一指标，以提高对心脏病患者的护理价值。PCI再入院与低风险的胸部不适和患者焦虑有关。因此，患者教育、改进的分诊机制以及改善护理协调为尽量减少PCI再入院提供了机会。由于PCI再入院情况常见且成本高昂，降低PCI再入院率为医疗服务提供机构提供了一个极具吸引力的目标，既能提高护理质量又能在涉及共同财务风险的合同中提升表现。
