Williams Jarrett, Kester Benjamin S, Bosco Joseph A, Slover James D, Iorio Richard, Schwarzkopf Ran
Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, New York.
J Arthroplasty. 2017 Mar;32(3):714-718. doi: 10.1016/j.arth.2016.09.005. Epub 2016 Sep 28.
To curb the unsustainable rise in health care expenses, health care payers are developing programs to incentivize hospitals and physicians to improve the value of care delivered to patients. Payers are utilizing various metrics, such as length of stay (LOS) and unplanned readmissions, to track progression of quality metrics. Relevant to orthopedic surgeons, the Centers for Medicare and Medicaid Services announced in 2015 the Comprehensive Care for Joint Replacement Payment Model-a program aimed at improving the quality of health care delivered to patients by shifting more of the financial risk of patient care onto providers.
We analyzed the medical records of 1329 consecutive lower extremity total joint patients enrolled in Centers for Medicare and Medicaid Services' Bundled Program for Care Improvement treated over a 21-month period. The goal of this study was to ascertain if hospital LOS is associated with unplanned readmissions within 90 days of admission for a total hip or knee arthroplasty.
After controlling for multiple demographic variables including sex, age, comorbidities and discharge location, we found that hospital LOS greater than 4 days is a significant risk factor for unplanned readmission within 90 days (odd ratio = 1.928, P = .010). Total knee arthroplasty (TKA) and discharge to a location other than home are also independent risk factors for 90-day readmission.
Our results demonstrate that increased LOS is a significant risk factor for readmission within 90 days of admission for a hip or knee arthroplasty in the Medicare population.
为遏制医疗费用的不可持续增长，医疗保健支付方正在制定计划，激励医院和医生提高为患者提供的医疗服务价值。支付方正在使用各种指标，如住院时间（LOS）和非计划再入院率，来跟踪质量指标的进展情况。与骨科医生相关的是，医疗保险和医疗补助服务中心于2015年宣布了全关节置换综合护理支付模式——该计划旨在通过将更多患者护理的财务风险转移到医疗服务提供者身上，提高为患者提供的医疗服务质量。
我们分析了在21个月期间参加医疗保险和医疗补助服务中心“改善护理捆绑计划”的1329例连续下肢全关节置换患者的病历。本研究的目的是确定全髋关节或膝关节置换术后住院时间是否与入院后90天内的非计划再入院有关。
在控制了包括性别、年龄、合并症和出院地点等多个人口统计学变量后，我们发现住院时间超过4天是90天内非计划再入院的一个重要风险因素（比值比=1.928，P = 0.010）。全膝关节置换术（TKA）和出院后回家以外的地点也是90天再入院的独立风险因素。
我们的结果表明，住院时间延长是医疗保险人群中髋关节或膝关节置换术后90天内再入院的一个重要风险因素。
