Horwitz Leora I, Bernheim Susannah M, Ross Joseph S, Herrin Jeph, Grady Jacqueline N, Krumholz Harlan M, Drye Elizabeth E, Lin Zhenqiu
*Department of Population Health, Division of Healthcare Delivery Science, New York University School of Medicine †Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center ‡Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, New York, NY §Center for Outcomes Research and Evaluation, Yale New Haven Health ∥Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine ¶Department of Medicine, Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine #Department of Health Policy and Management, Yale School of Public Health **Department of Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT ††Health Research and Educational Trust, Chicago, IL ‡‡Department of Pediatrics, Yale School of Medicine, New Haven, CT.
Med Care. 2017 May;55(5):528-534. doi: 10.1097/MLR.0000000000000713.
Safety-net and teaching hospitals are somewhat more likely to be penalized for excess readmissions, but the association of other hospital characteristics with readmission rates is uncertain and may have relevance for hospital-centered interventions.
To examine the independent association of 8 hospital characteristics with hospital-wide 30-day risk-standardized readmission rate (RSRR).
This is a retrospective cross-sectional multivariable analysis.
US hospitals.
Centers for Medicare and Medicaid Services specification of hospital-wide RSRR from July 1, 2013 through June 30, 2014 with race and Medicaid dual-eligibility added.
We included 6,789,839 admissions to 4474 hospitals of Medicare fee-for-service beneficiaries aged over 64 years. In multivariable analyses, there was regional variation: hospitals in the mid-Atlantic region had the highest RSRRs [0.98 percentage points higher than hospitals in the Mountain region; 95% confidence interval (CI), 0.84-1.12]. For-profit hospitals had an average RSRR 0.38 percentage points (95% CI, 0.24-0.53) higher than public hospitals. Both urban and rural hospitals had higher RSRRs than those in medium metropolitan areas. Hospitals without advanced cardiac surgery capability had an average RSRR 0.27 percentage points (95% CI, 0.18-0.36) higher than those with. The ratio of registered nurses per hospital bed was not associated with RSRR. Variability in RSRRs among hospitals of similar type was much larger than aggregate differences between types of hospitals.
Overall, larger, urban, academic facilities had modestly higher RSRRs than smaller, suburban, community hospitals, although there was a wide range of performance. The strong regional effect suggests that local practice patterns are an important influence. Disproportionately high readmission rates at for-profit hospitals may highlight the role of financial incentives favoring utilization.
安全网医院和教学医院因再入院率过高而受到处罚的可能性略高，但其他医院特征与再入院率之间的关联尚不确定，可能与以医院为中心的干预措施相关。
研究8种医院特征与全院30天风险标准化再入院率（RSRR）之间的独立关联。
这是一项回顾性横断面多变量分析。
美国医院。
医疗保险和医疗补助服务中心对2013年7月1日至2014年6月30日期间全院RSRR的规定，并增加了种族和医疗补助双重资格。
我们纳入了4474家医院中64岁以上医疗保险按服务收费受益人的6789839例住院病例。在多变量分析中，存在地区差异：大西洋中部地区的医院RSRR最高[比山区医院高0.98个百分点；95%置信区间（CI），0.84 - 1.12]。营利性医院的平均RSRR比公立医院高0.38个百分点（95%CI，0.24 - 0.53）。城市和农村医院的RSRR均高于中等城市地区的医院。没有先进心脏手术能力的医院平均RSRR比有该能力的医院高0.27个百分点（95%CI，0.18 - 0.36）。每医院床位的注册护士比例与RSRR无关。同类医院之间RSRR的变异性远大于不同类型医院之间的总体差异。
总体而言，大型、城市、学术性医疗机构的RSRR略高于小型、郊区、社区医院，尽管表现差异很大。强烈的地区效应表明当地的医疗实践模式是一个重要影响因素。营利性医院过高的再入院率可能凸显了有利于利用的财务激励措施的作用。
