种族/民族和社会经济地位对髋膝关节置换术后风险调整后的医院再入院率的影响
Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty.
作者信息
Martsolf Grant R, Barrett Marguerite L, Weiss Audrey J, Kandrack Ryan, Washington Raynard, Steiner Claudia A, Mehrotra Ateev, SooHoo Nelson F, Coffey Rosanna
机构信息
RAND Corporation, Pittsburgh, Pennsylvania
M.L. Barrett, Inc., San Diego, California.
出版信息
J Bone Joint Surg Am. 2016 Aug 17;98(16):1385-91. doi: 10.2106/JBJS.15.00884.
BACKGROUND
Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital's control, may not accurately reflect a hospital's performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA.
METHODS
We calculated 2 sets of risk-adjusted readmission rates by (1) using the Centers for Medicare & Medicaid Services standard risk-adjustment algorithm that incorporates patient age, sex, comorbidities, and hospital effects and (2) adding race/ethnicity and socioeconomic status to the model. Using data from the Healthcare Cost and Utilization Project, 2011 State Inpatient Databases, we compared the relative performances of 1,194 hospitals across the 2 methods.
RESULTS
Addition of race/ethnicity and socioeconomic status to the risk-adjustment algorithm resulted in (1) little or no change in the risk-adjusted readmission rates at nearly all hospitals; (2) no change in the designation of the readmission rate as better, worse, or not different from the population mean at >99% of the hospitals; and (3) no change in the excess readmission ratio at >97% of the hospitals.
CONCLUSIONS
Inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at <3% of the hospitals. We believe that policymakers and payers should consider this result when deciding whether to include race/ethnicity and socioeconomic status in risk-adjusted THA and TKA readmission rates used for hospital accountability, payment, and public reporting.
LEVEL OF EVIDENCE
Prognostic Level III. See instructions for Authors for a complete description of levels of evidence.
背景
全髋关节置换术（THA）和全膝关节置换术（TKA）后的再入院率越来越多地被用于衡量医院绩效。未对种族/民族和社会经济地位以及医院无法控制的患者风险因素进行调整的再入院率，可能无法准确反映医院绩效。在本研究中，我们探讨了针对种族/民族和社会经济地位进行风险调整在多大程度上影响了THA和TKA术后再入院率方面的医院绩效。
方法
我们通过以下两种方式计算了两组风险调整后的再入院率：（1）使用医疗保险和医疗补助服务中心的标准风险调整算法，该算法纳入了患者年龄、性别、合并症和医院效应；（2）在模型中加入种族/民族和社会经济地位。利用2011年州住院患者数据库中医疗成本和利用项目的数据，我们比较了1194家医院在这两种方法下的相对绩效。
结果
在风险调整算法中加入种族/民族和社会经济地位导致：（1）几乎所有医院的风险调整后再入院率几乎没有变化或没有变化；（2）超过99%的医院在将再入院率指定为优于、差于或与总体均值无差异方面没有变化；（3）超过97%的医院在超额再入院率方面没有变化。
结论
在风险调整算法中纳入种族/民族和社会经济地位，导致在THA和TKA术后再入院率方面，不到3%的医院出现相对绩效变化。我们认为，政策制定者和支付方在决定是否将种族/民族和社会经济地位纳入用于医院问责、支付和公开报告的风险调整后的THA和TKA再入院率时，应考虑这一结果。
证据水平
预后水平III。有关证据水平的完整描述，请参阅作者指南。
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