Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Durham, North Carolina.
J Am Coll Cardiol. 2016 Mar 1;67(8):963-972. doi: 10.1016/j.jacc.2015.12.037.
In 2009, the Centers for Medicare & Medicaid Services (CMS) began publicly reporting 30-day hospital readmission rates for patients discharged with acute myocardial infarction (MI), heart failure (HF), or pneumonia.
This study assessed trends of 30-day readmission rates and post-discharge care since the implementation of CMS public reporting.
We analyzed Medicare claims data from 2006 to 2012 for patients discharged after a hospitalization for MI, HF, or pneumonia. For each diagnosis, we estimated trends in 30-day all-cause readmissions and post-discharge care (emergency department visits and observation stays) by using hospitalization-level regression models. We modeled adjusted trends before and after the implementation of public reporting. To assess for a change in trend, we tested the difference between the slope before implementation and the slope after implementation.
We analyzed 37,829 hospitalizations for MI, 100,189 for HF, and 79,076 for pneumonia from >4,100 hospitals. When considering only recent trends (i.e., since 2009), we found improvements in adjusted readmission rates for MI (-2.3%), HF (-1.8%), and pneumonia (-2.0%), but when comparing the trend before public reporting with the trend after reporting, there was no difference for MI (p = 0.72), HF (p = 0.19), or pneumonia (p = 0.21). There were no changes in trends for 30-day post-discharge care for MI or pneumonia; however, the trend decreased for HF emergency department visits from 2.3% to -0.8% (p = 0.007) and for observation stays from 15.1% to 4.1% (p = 0.04).
The release of the CMS public reporting of hospital readmission rates was not associated with any measurable change in 30-day readmission trends for MI, HF, or pneumonia, but it was associated with less hospital-based acute care for HF.
2009 年，医疗保险和医疗补助服务中心（CMS）开始公开报告因急性心肌梗死（MI）、心力衰竭（HF）或肺炎出院的患者 30 天内的再入院率。
本研究评估了 CMS 公开报告实施以来 30 天再入院率和出院后护理的趋势。
我们分析了 2006 年至 2012 年 Medicare 索赔数据，这些患者在因 MI、HF 或肺炎住院后出院。对于每种诊断，我们使用住院水平回归模型来估计 30 天内全因再入院和出院后护理（急诊就诊和观察住院）的趋势。我们在公开报告实施前后模拟了调整后的趋势。为了评估趋势的变化，我们测试了实施前斜率和实施后斜率之间的差异。
我们分析了来自 4100 多家医院的 37829 例 MI 住院、100189 例 HF 住院和 79076 例肺炎住院。仅考虑最近的趋势（即自 2009 年以来），我们发现 MI（-2.3%）、HF（-1.8%）和肺炎（-2.0%）的调整后再入院率有所改善，但当比较公开报告前的趋势与报告后的趋势时，MI（p=0.72）、HF（p=0.19）或肺炎（p=0.21）之间没有差异。MI 或肺炎 30 天出院后护理的趋势没有变化；然而，HF 急诊就诊的趋势从 2.3%降至-0.8%（p=0.007），观察住院的趋势从 15.1%降至 4.1%（p=0.04）。
CMS 公开报告医院再入院率与 MI、HF 或肺炎 30 天再入院趋势的任何可衡量变化均无关，但与 HF 的医院急性护理减少有关。
