被3M潜在可预防再入院软件标记为潜在可预防的急性心肌梗死和心力衰竭再入院是否存在更多护理过程问题？

Do Acute Myocardial Infarction and Heart Failure Readmissions Flagged as Potentially Preventable by the 3M Potentially Preventable Readmissions Software Have More Process-of-Care Problems?

作者信息

Borzecki Ann M, Chen Qi, Mull Hillary J, Shwartz Michael, Bhatt Deepak L, Hanchate Amresh, Rosen Amy K

机构信息

From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.).

出版信息

Circ Cardiovasc Qual Outcomes. 2016 Sep;9(5):532-41. doi: 10.1161/CIRCOUTCOMES.115.002509. Epub 2016 Sep 6.

DOI:10.1161/CIRCOUTCOMES.115.002509

PMID:27601460

Abstract

BACKGROUND

The 3M Potentially Preventable Readmissions (3M-PPR) software matches clinically related index admission and readmission diagnoses that may signify in-hospital or postdischarge quality problems. To assess whether the PPR algorithm identifies preventable readmissions, we compared processes of care between PPR software-flagged and nonflagged cases.

METHODS AND RESULTS

Using 2006 to 2010 national VA administrative data, we identified acute myocardial infarction and heart failure discharges associated with 30-day all-cause readmissions, then flagged cases (PPR-Yes/PPR-No) using the 3M-PPR software. To assess care quality, we abstracted medical records of 100 readmissions per condition using tools containing explicit processes organized into admission work-up, in-hospital evaluation/treatment, discharge readiness, postdischarge period. We derived quality scores, scaled to a maximum of 25 per section (maximum total score=100) and compared cases on total and section-specific mean scores. For acute myocardial infarction, 77 of 100 cases were flagged as PPR-Yes. Section quality scores were highest for in-hospital evaluation/treatment (20.5±2.8) and lowest for postdischarge care (6.8±9.1). Total and section-related mean scores did not differ by PPR status; respective PPR-Yes versus PPR-No total scores were 61.6±11.1 and 60.4±9.4; P=0.98. For heart failure, 86 of 100 cases were flagged as PPR-Yes. Section scores were highest for discharge readiness (18.8±2.4) and lowest for postdischarge care (7.3±8.1). Like acute myocardial infarction, total and section-related mean scores did not differ by PPR status; PPR-Yes versus PPR-No total scores were 61.2±10.8 and 63.4±7.0, respectively; P=0.47.

CONCLUSIONS

Among VA acute myocardial infarction and heart failure readmissions, the 3M-PPR software does not distinguish differences in case-level quality of care. Whether 3M-PPR software better identifies preventable readmissions by using other methods to capture poorly documented processes or performing different comparisons requires further study.

摘要

背景

3M潜在可预防再入院（3M-PPR）软件可匹配临床相关的索引入院和再入院诊断，这些诊断可能表明住院期间或出院后存在质量问题。为了评估PPR算法是否能识别可预防的再入院情况，我们比较了PPR软件标记的病例和未标记病例之间的护理过程。

方法与结果

利用2006年至2010年美国退伍军人事务部（VA）的全国行政数据，我们确定了与30天全因再入院相关的急性心肌梗死和心力衰竭出院病例，然后使用3M-PPR软件标记病例（PPR-是/PPR-否）。为了评估护理质量，我们使用包含明确流程的工具，从每种疾病的100例再入院病例中提取医疗记录，这些流程分为入院检查、住院评估/治疗、出院准备、出院后阶段。我们得出质量得分，每个部分的最高分为25分（总分最高为100分），并比较病例的总分和各部分的平均得分。对于急性心肌梗死，100例病例中有77例被标记为PPR-是。住院评估/治疗部分的质量得分最高（20.5±2.8），出院后护理部分的得分最低（6.8±9.1）。总分和各部分相关的平均得分在PPR状态上没有差异；PPR-是组与PPR-否组的总分分别为61.6±11.1和60.4±9.4；P=0.98。对于心力衰竭，100例病例中有86例被标记为PPR-是。出院准备部分的得分最高（18.8±2.4），出院后护理部分的得分最低（7.3±8.1）。与急性心肌梗死一样，总分和各部分相关的平均得分在PPR状态上没有差异；PPR-是组与PPR-否组的总分分别为61.2±10.8和63.4±7.0；P=0.47。