加利福尼亚州医院再入院率降低计划对不同保险类型的影响。
The Impact of the Hospital Readmissions Reduction Program across Insurance Types in California.
作者信息
Zingmond David S, Liang Li-Jung, Parikh Punam, Escarce José J
机构信息
Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA.
VA Greater Los Angeles Healthcare System, Los Angeles, CA.
出版信息
Health Serv Res. 2018 Dec;53(6):4403-4415. doi: 10.1111/1475-6773.12869. Epub 2018 May 8.
OBJECTIVE
Examine 30-day readmission rates for indicator conditions before and after adoption of the Hospital Readmissions Reduction Program (HRRP).
DATA
California hospital discharge data, 2005 to 2014.
STUDY DESIGN
Estimated difference between pre-HRRP trends and post-HRRP rates of hospital readmissions after hospitalization for indicator conditions targeted by the HRRP (heart attack, heart failure, and pneumonia) by payer among insured adults.
PRINCIPAL FINDINGS
Post-HRRP, reductions occurred for the three conditions among Fee-for-Service (FFS) Medicare. Readmissions decreased for heart attack and heart failure in Medicare Managed Care (MC). No reductions were observed in the younger commercially insured.
CONCLUSIONS
Post-HRRP, greater than expected reductions occurred in rehospitalizations for patients with Medicare FFS and Medicare MC. HRRP incentives may be influencing system-wide changes influencing care outside of traditional Medicare.
目的
研究采用医院再入院率降低计划（HRRP）前后指标性疾病的30天再入院率。
数据
2005年至2014年加利福尼亚州医院出院数据。
研究设计
按付款人分类，估算HRRP实施前趋势与HRRP实施后因HRRP所针对的指标性疾病（心脏病发作、心力衰竭和肺炎）住院后再入院率之间的差异，研究对象为参保成年人。
主要发现
HRRP实施后，按服务收费（FFS）的医疗保险中，这三种疾病的再入院率有所降低。医疗保险管理式医疗（MC）中，心脏病发作和心力衰竭的再入院率下降。在年轻的商业保险参保者中未观察到再入院率降低。
结论
HRRP实施后，FFS医疗保险和医疗保险管理式医疗参保患者的再入院率降幅超过预期。HRRP激励措施可能正在影响全系统的变化，进而影响传统医疗保险之外的医疗服务。
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