医疗保险住院患者死亡率的公开报告及报告疾病的死亡率趋势
Public Reporting of Mortality Rates for Hospitalized Medicare Patients and Trends in Mortality for Reported Conditions.
作者信息
Joynt Karen E, Orav E John, Zheng Jie, Jha Ashish K
出版信息
Ann Intern Med. 2016 Aug 2;165(3):153-60. doi: 10.7326/M15-1462. Epub 2016 May 31.
BACKGROUND
Public reporting is seen as a powerful quality improvement tool, but data to support its efficacy are limited. The Centers for Medicare & Medicaid Services' Hospital Compare program initially reported process metrics only but started reporting mortality rates for acute myocardial infarction, heart failure, and pneumonia in 2008.
OBJECTIVE
To determine whether public reporting of mortality rates was associated with lower mortality rates for these conditions among Medicare beneficiaries.
DESIGN
For 2005 to 2007, process-only reporting was considered; for 2008 to 2012, process and mortality reporting was considered. Changes in mortality trends before and during reporting periods were estimated by using patient-level hierarchical modeling. Nonreported medical conditions were used as a secular control.
SETTING
U.S. acute care hospitals.
PARTICIPANTS
20 707 266 fee-for-service Medicare beneficiaries hospitalized from January 2005 through November 2012.
MEASUREMENTS
30-day risk-adjusted mortality rates.
RESULTS
Mortality rates for the 3 publicly reported conditions were changing at an absolute rate of -0.23% per quarter during process-only reporting, but this change slowed to a rate of -0.09% per quarter during process and mortality reporting (change, 0.13% per quarter; 95% CI, 0.12% to 0.14%). Mortality for nonreported conditions was changing at -0.17% per quarter during process-only reporting and slowed slightly to -0.11% per quarter during process and mortality reporting (change, 0.06% per quarter; CI, 0.05% to 0.07%).
LIMITATION
Administrative data may have limited ability to account for changes in patient complexity over time.
CONCLUSION
Changes in mortality trends suggest that reporting in Hospital Compare was associated with a slowing, rather than an improvement, in the ongoing decline in mortality among Medicare patients.
PRIMARY FUNDING SOURCE
National Heart, Lung, and Blood Institute.
背景
公开报告被视为一种强大的质量改进工具，但支持其有效性的数据有限。医疗保险和医疗补助服务中心的医院比较项目最初仅报告过程指标，但在2008年开始报告急性心肌梗死、心力衰竭和肺炎的死亡率。
目的
确定公开报告死亡率是否与医疗保险受益人中这些疾病的较低死亡率相关。
设计
2005年至2007年，考虑仅报告过程指标；2008年至2012年，考虑报告过程指标和死亡率。通过使用患者层面的分层模型估计报告期之前和期间死亡率趋势的变化。未报告的医疗状况用作长期对照。
地点
美国急症护理医院。
参与者
2005年1月至2012年11月期间住院的20707266名按服务收费的医疗保险受益人。
测量指标
30天风险调整死亡率。
结果
在仅报告过程指标期间，3种公开报告疾病的死亡率以每季度-0.23%的绝对速率变化，但在报告过程指标和死亡率期间，这一变化减缓至每季度-0.09%（变化为每季度0.13%；95%CI，0.12%至0.14%）。在仅报告过程指标期间，未报告疾病的死亡率以每季度-0.17%的速率变化，在报告过程指标和死亡率期间略微减缓至每季度-0.11%（变化为每季度0.06%；CI，0.05%至0.07%）。
局限性
行政数据可能难以充分反映患者病情复杂性随时间的变化。
结论
死亡率趋势的变化表明，医院比较项目中的报告与医疗保险患者死亡率持续下降的放缓相关，而非改善。
主要资金来源
国家心肺血液研究所。
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