Unruh Mark A, Jung Hye-Young, Vest Joshua R, Casalino Lawrence P, Kaushal Rainu
*Department of Healthcare Policy & Research †Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, NY ‡Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN §Department of Pediatrics, Weill Cornell Medical College ∥New York-Presbyterian Hospital ¶Department of Medicine, Weill Cornell Medical College, New York, NY.
Med Care. 2017 May;55(5):493-499. doi: 10.1097/MLR.0000000000000695.
Nearly one-fifth of hospitalized Medicare fee-for-service beneficiaries are readmitted within 30 days. Participation in the Meaningful Use initiative among outpatient physicians may reduce readmissions.
To evaluate the impact of outpatient physicians' participation in Meaningful Use on readmissions.
The study population included 90,774 Medicare fee-for-service beneficiaries from New York State (2010-2012). We compared changes in the adjusted odds of readmission for patients of physicians who participated in Meaningful Use-stage 1, before and after attestation as meaningful users, with concurrent patients of matched control physicians who used paper records or electronic health records without Meaningful Use participation. Three secondary analyses were conducted: (1) limited to patients with 3+ Elixhauser comorbidities; (2) limited to patients with conditions used by Medicare to penalize hospitals with high readmission rates (acute myocardial infarction, congestive heart failure, and pneumonia); and (3) using only patients of physicians with electronic health records who were not meaningful users as the controls.
Thirty-day readmission.
Patients of Meaningful Use physicians had 6% lower odds of readmission compared with patients of physicians who were not meaningful users, but the estimate was not statistically significant (odds ratio: 0.94, 95% confidence interval, 0.88-1.01). Estimated odds ratios from secondary analyses were broadly consistent with our primary analysis.
Physician participation in Meaningful Use was not associated with reduced readmissions. Additional studies are warranted to see if readmissions decline in future stages of Meaningful Use where more emphasis is placed on health information exchange and outcomes.
近五分之一的住院医疗保险按服务收费受益人在30天内再次入院。门诊医生参与“有意义使用”计划可能会减少再次入院率。
评估门诊医生参与“有意义使用”计划对再次入院率的影响。
研究人群包括来自纽约州的90774名医疗保险按服务收费受益人（2010 - 2012年）。我们比较了参与“有意义使用”第一阶段的医生的患者在认证为有意义使用者之前和之后再次入院调整后的几率变化，以及使用纸质记录或未参与“有意义使用”的电子健康记录的匹配对照医生的同期患者。进行了三项二次分析：（1）仅限于患有3种及以上埃利克斯豪泽共病的患者；（2）仅限于患有医疗保险用于惩罚高再入院率医院的疾病（急性心肌梗死、充血性心力衰竭和肺炎）的患者；（3）仅将未成为有意义使用者的电子健康记录医生的患者作为对照。
30天再次入院率。
参与“有意义使用”计划的医生的患者再次入院几率比未参与的医生的患者低6%，但该估计值无统计学意义（优势比：0.94，95%置信区间，0.88 - 1.01）。二次分析得出的估计优势比与我们的主要分析大致一致。
医生参与“有意义使用”计划与再次入院率降低无关。有必要进行更多研究，以观察在更强调健康信息交换和结果的“有意义使用”未来阶段，再次入院率是否会下降。
