Pronovost Peter J, Brotman Daniel J, Hoyer Erik H, Deutschendorf Amy
Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Departments of Anesthesiology and Critical Care Medicine, Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Hosp Med. 2017 Dec;12(12):1009-1011. doi: 10.12788/jhm.2799. Epub 2017 Aug 23.
Current hospital readmission measures are part of the Centers for Medicare & Medicaid Services Five-Star Quality Rating System but are inadequate for reporting hospital quality. We review potential biases in the readmission measures and offer policy recommendations to address these biases. Hospital readmission rates are influenced by multiple sources of variation (eg, mix of patients served, bias in the performance measure); true differences in quality of care are often a much smaller source of this variation. Thus, variation from caring for large proportions of socioeconomically disadvantaged or tertiary-care patients will bias a hospital's ratings. Ratings aside, readmission measures may indirectly harm patients because low readmission rates do not correlate with reduced mortality, yet the Five-Star Quality Rating System weighs readmission equally with mortality. We propose that hospital quality rankings not use readmission measures as currently constructed.
当前的医院再入院率衡量指标是医疗保险和医疗补助服务中心五星级质量评级系统的一部分，但不足以用于报告医院质量。我们审视了再入院率衡量指标中存在的潜在偏差，并提出政策建议以解决这些偏差。医院再入院率受多种变异来源的影响（例如，所服务患者的构成、绩效衡量中的偏差）；护理质量的真正差异往往只是这种变异的一个小得多的来源。因此，因护理大量社会经济地位不利或三级护理患者而产生的变异会使医院评级产生偏差。抛开评级不谈，再入院率衡量指标可能会间接伤害患者，因为低再入院率与死亡率降低并无关联，但五星级质量评级系统却将再入院率与死亡率同等看待。我们建议医院质量排名不要采用目前构建的再入院率衡量指标。
