Division of Cardiology, University of California, Riverside, California.
Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina.
Am Heart J. 2018 Jun;200:127-133. doi: 10.1016/j.ahj.2017.11.018. Epub 2018 Jan 8.
Medicare utilizes 30-day risk-standardized readmission rates (RSRR) as a measure of hospital quality and applies penalties based on this measure. The objective of this study was to identify the relationship between hospital performance on 30-day RSRR in heart failure (HF) patients and long-term patient survival.
Data were collected from Get With The Guidelines (GWTG)-HF and linked with Medicare data. Based on hospital performance for 30-day RSRR, hospitals were grouped into performance quartiles: top 25% (N=11,181), 25-50% (N=10,367), 50-75% (N=8729), and bottom 25% (N=7180). The primary outcome was mortality at 3 years applying Cox proportional hazards regression adjusted for patient and hospital characteristics.
The overall 30-day readmission rate was 19.8% and the 3-year mortality rates were 61.8%, 61.0%, 62.6%, and 59.9% for top 25%, 25-50%, 50-75%, and bottom 25% hospitals for 30-day RSRR performance, respectively. Compared to bottom 25% performing hospitals, adjusted hazard ratios (HR) for 3-year mortality were HR 0.96 (95% confidence interval [CI] 0.90-1.01), HR 0.89 (95% CI 0.84-0.94), HR 1.01 (95% CI 0.95-1.06) for the top 25%, 25-50% and 50-75% hospitals respectively. Median survival time was highest for the bottom 25% hospitals on the 30-day RSRR metric.
Hospital performance on 30-day readmissions in HF has no or little association with risk adjusted 3-year mortality or median survival. There is a compelling need to utilize more meaningful and patient-centered outcome measures for reporting and incentivizing quality care for HF.
医疗保险利用 30 天风险标准化再入院率（RSRR）作为衡量医院质量的指标，并根据该指标进行处罚。本研究的目的是确定心力衰竭（HF）患者 30 天 RSRR 与长期患者生存率之间的关系。
从 Get With The Guidelines（GWTG）-HF 中收集数据，并与医疗保险数据相关联。根据 30 天 RSRR 的医院表现，将医院分为绩效四分位数：前 25%（N=11181）、25-50%（N=10367）、50-75%（N=8729）和后 25%（N=7180）。主要结果是应用 Cox 比例风险回归调整患者和医院特征后的 3 年死亡率。
总体 30 天再入院率为 19.8%，3 年死亡率分别为前 25%、25-50%、50-75%和后 25%医院的 61.8%、61.0%、62.6%和 59.9%。与后 25%表现不佳的医院相比，3 年死亡率的调整后的危险比（HR）分别为 HR 0.96（95%置信区间[CI]0.90-1.01）、HR 0.89（95% CI 0.84-0.94）、HR 1.01（95% CI 0.95-1.06）。30 天 RSRR 指标下，中位生存时间最高的是后 25%的医院。
HF 患者 30 天再入院的医院表现与风险调整后 3 年死亡率或中位生存时间没有或几乎没有关联。迫切需要利用更有意义和以患者为中心的结果衡量标准来报告和激励 HF 的优质护理。
