Goldberg Elizabeth M, Morphis Blake, Youssef Rouba, Gardner Rebekah
Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI; Post-doctoral Research Fellow, Center of Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI.
Healthcentric Advisors, Providence, RI.
R I Med J (2013). 2017 Aug 1;100(8):23-28.
Background: The Hospital Readmission Reduction Program was instituted by the Centers for Medicare & Medicaid Services in 2012 to incentivize hospitals to reduce readmissions.
To examine the most common diagnoses driving readmissions among fee-for-service Medicare beneficiaries in the hospitals with the highest and lowest readmission performance in Southern New England from 2014 to 2016.
This is a retrospective observational study using publicly available Hospital Compare data and Medicare Part A claims data. Hospitals were ranked based on risk-adjusted excess readmission ratios. Patient demographic and hospital characteristics were compared for the two cohorts using t-tests. The percentages of readmissions in each cohort attributable to the top three readmission diagnoses were examined.
Highest-performing hospitals readmitted a significantly lower percentage of black patients (p=0.03), were less urban (p<0.01), and had higher Hospital Compare Star ratings (p=0.01). Lowest-performing hospitals readmitted higher percentages of patients for sepsis (9.4% [95%CI: 8.8%-10.0%] vs. 8.1% [95%CI: 7.4%-8.7%]) and complications of device, implant, or graft (3.2% [95%CI: 2.5%-3.9%] vs. 0.2% [95%CI: 0.1%-0.6%]), compared to highest-performing hospitals.
Ongoing efforts to improve care transitions may be strengthened by targeting early infection surveillance, promoting adherence to surgical treatment guidelines, and improving communication between hospitals and post-acute care facilities. [Full article available at http://rimed.org/rimedicaljournal-2017-08.asp].
背景：医疗保险和医疗补助服务中心于2012年设立了医院再入院率降低计划，以激励医院减少再入院情况。
研究2014年至2016年在新英格兰南部再入院表现最高和最低的医院中，导致按服务收费的医疗保险受益人次再入院的最常见诊断。
这是一项回顾性观察性研究，使用公开可用的医院比较数据和医疗保险A部分索赔数据。医院根据风险调整后的超额再入院率进行排名。使用t检验比较两个队列的患者人口统计学和医院特征。检查了每个队列中归因于前三大再入院诊断的再入院百分比。
表现最佳的医院收治的黑人患者再入院百分比显著较低（p = 0.03），城市化程度较低（p < 0.01），且医院比较星级评分较高（p = 0.01）。与表现最佳的医院相比，表现最差的医院因败血症再入院的患者百分比更高（9.4% [95%CI：8.8%-10.0%] 对 8.1% [95%CI：7.4%-8.7%]），以及因器械、植入物或移植物并发症再入院的患者百分比更高（3.2% [95%CI：2.5%-3.9%] 对 0.2% [95%CI：0.1%-0.6%]）。
通过针对早期感染监测、促进对手术治疗指南的遵守以及改善医院与急性后护理设施之间的沟通，可能会加强持续改善护理过渡的努力。[全文可在http://rimed.org/rimedicaljournal-2017-08.asp获取]
