Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (N.M.B., J.H.W.).
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (D.B.K., C.S., J.B.S., L.R.V., R.W.Y.).
Ann Intern Med. 2018 May 1;168(9):631-639. doi: 10.7326/M17-1492. Epub 2018 Mar 27.
Readmission rates after hospitalizations for heart failure (HF), acute myocardial infarction (AMI), and pneumonia among Medicare beneficiaries are used to assess quality and determine reimbursement. Whether these measures reflect readmission rates for other conditions or insurance groups is unknown.
To investigate whether hospital-level 30-day readmission measures for publicly reported conditions (HF, AMI, and pneumonia) among Medicare patients reflect those for Medicare patients hospitalized for unreported conditions or non-Medicare patients hospitalized with HF, AMI, or pneumonia.
Cross-sectional.
Population-based.
Hospitals in the all-payer Nationwide Readmissions Database in 2013 and 2014.
Hospital-level 30-day all-cause risk-standardized excess readmission ratios (ERRs) were compared for 3 groups of patients: Medicare beneficiaries admitted for HF, AMI, or pneumonia (Medicare reported group); Medicare beneficiaries admitted for other conditions (Medicare unreported group); and non-Medicare beneficiaries admitted for HF, AMI, or pneumonia (non-Medicare group).
Within-hospital differences in ERRs varied widely among groups. Medicare reported ratios differed from Medicare unreported ratios by more than 0.1 for 29% of hospitals and from non-Medicare ratios by more than 0.1 for 46% of hospitals. Among hospitals with higher readmission ratios, ERRs for the Medicare reported group tended to overestimate ERRs for the non-Medicare group but underestimate those for the Medicare unreported group.
Medicare groups and risk adjustment differed slightly from those used by the Centers for Medicare & Medicaid Services.
Hospital ERRs, as estimated by Medicare to determine financial penalties, have poor agreement with corresponding measures for populations and conditions not tied to financial penalties. Current publicly reported measures may not be good surrogates for overall hospital quality related to 30-day readmissions.
Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.
医疗保险受益人心力衰竭（HF）、急性心肌梗死（AMI）和肺炎住院后的再入院率用于评估质量并确定报销。这些措施是否反映了其他条件或保险群体的再入院率尚不清楚。
调查医疗保险患者报告的条件（HF、AMI 和肺炎）的医院水平 30 天再入院率是否反映了医疗保险患者因未报告条件住院或非医疗保险患者因 HF、AMI 或肺炎住院的再入院率。
横断面研究。
基于人群。
2013 年和 2014 年全美再入院数据库中的医院。
比较了 3 组患者的医院水平 30 天全因风险标准化过度再入院率（ERR）：因 HF、AMI 或肺炎住院的医疗保险受益（医疗保险报告组）；因其他疾病住院的医疗保险受益（医疗保险未报告组）；因 HF、AMI 或肺炎住院的非医疗保险受益（非医疗保险组）。
组内医院 ERR 差异差异很大。29%的医院医疗保险报告组的比率与医疗保险未报告组的比率相差超过 0.1，46%的医院医疗保险报告组的比率与非医疗保险组的比率相差超过 0.1。在再入院率较高的医院中，医疗保险报告组的 ERR 倾向于高估非医疗保险组的 ERR，但低估医疗保险未报告组的 ERR。
医疗保险组和风险调整与医疗保险和医疗补助服务中心使用的略有不同。
医疗保险用来确定经济处罚的医院 ERR 与与 30 天再入院无关的人群和条件的相应措施吻合度较差。目前公开报告的措施可能不是衡量与 30 天再入院相关的整体医院质量的良好替代指标。
Richard A. 和 Susan F. Smith 心脏科结局研究中心。
