Department of Health Policy and Management.
Department of Surgery, Massachusetts General Hospital.
Ann Surg. 2018 Apr;267(4):599-605. doi: 10.1097/SLA.0000000000002350.
The aim of this study was to investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a "spillover" effect on surgical conditions.
During the past decade, there have been multiple national efforts to improve surgical care. Readmission rates are a key metric for assessing surgical quality. Whether surgical readmission rates have declined, and whether the Hospital Readmissions Reduction Program has had an influence is unclear.
Using national Medicare data, we identified patients undergoing a range of procedures during the past decade. We examined whether certain procedures that would be targeted by the HRRP had a differential change in readmissions compared to other procedures. We used an interrupted time-series model to examine readmission trends in three time periods: pre-ACA, HRRP implementation, and HRRP penalty.
Between 2005 and 2014, 17,423,106 patients underwent the procedures of interest; risk-adjusted rates of readmission across the 8 procedures declined from 12.2% to 8.6%. Pre-ACA rates of readmission were decreasing [-0.060% per quarter (-0.072%, -0.048%), P < 0.001]. During the HRRP implementation period, the rate of decline of readmissions increased [-0.129% (-0.142%, -0.116%), P < 0.001] and continued declining at a similar rate during the penalty period [-0.118% (-0.131%, -0.105%), P < 0.001]. Largest declines in surgical readmissions were seen among the nontargeted procedures. The hospitals with the greatest reductions in medical readmissions also had the greatest drop in surgical readmissions.
Surgical readmission rates have fallen during the past decade and rates of decline have increased during the HRRP period.
本研究旨在探讨医院再入院率削减计划（一项针对某些医疗条件下高再入院率引入经济处罚的全国性计划）是否对手术条件产生了“溢出效应”。
在过去的十年中，已经有多项旨在改善外科护理的全国性努力。再入院率是评估手术质量的关键指标。目前尚不清楚手术再入院率是否有所下降，以及医院再入院率削减计划是否有影响。
我们使用国家医疗保险数据，确定了过去十年中进行各种手术的患者。我们研究了 HRRP 可能针对的某些手术与其他手术相比，再入院率是否有差异变化。我们使用中断时间序列模型，在三个时间段（ACA 前、HRRP 实施和 HRRP 处罚）检查再入院趋势：2005 年至 2014 年，共有 17423106 名患者接受了感兴趣的手术；8 种手术的风险调整后再入院率从 12.2%降至 8.6%。ACA 前的再入院率呈下降趋势[-0.060%每季度（-0.072%，-0.048%），P < 0.001]。在 HRRP 实施期间，再入院率的下降速度加快[-0.129%（-0.142%，-0.116%），P < 0.001]，并在处罚期间以相似的速度继续下降[-0.118%（-0.131%，-0.105%），P < 0.001]。非靶向手术的外科再入院率降幅最大。医疗再入院率降幅最大的医院，外科再入院率降幅也最大。
在过去十年中，外科再入院率有所下降，在 HRRP 期间下降速度加快。
