Manickam Raj N, Memtsoudis Stavros G, Mu Yi, Kim Jeehyoung, Kshirsagar Abhijit V, Bang Heejung
Graduate Group in Epidemiology, University of California, Davis, California; Center for Healthcare Policy and Research, School of Medicine, University of California, Sacramento, California.
Department of Anesthesiology, Hospital for Special Surgery, New York, New York; Departments of Anesthesiology and Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
J Surg Orthop Adv. 2018 Winter;27(4):286-294.
Whether factors not under a hospital's control affect readmissions remains intensely debated in the context of the Centers for Medicare & Medicaid Services' Hospital Readmission Reduction Program. This study aimed to evaluate the potential effects of poverty, race, and hospital volume on excess readmissions, with >3000 hospitals participating in "Hospital Compare." Correlations between excess readmission ratios for five eligible outcomes (including hip and knee arthroplasty) were assessed with the three area and hospital-level factors: poverty, race (percent of black population), and hospital volume (number of discharges). Correlation coefficients of the ratios with race were approximately r = 0.2, consistently larger than those with poverty (r = 0-0.1), and those with volume were r = 0 to -0.5. Hip and knee arthroplasty had unique findings: null correlation with poverty (r ≈ 0), largest variability, and strong monotonicity with volume (r ≈ -0.5). The percent of Hispanic population showed negligible correlations in secondary analysis. Penalty assessment and hospital profiling should consider areas with high percentages of black population and a small volume of hospitals and providers of hip and knee surgery. (Journal of Surgical Orthopaedic Advances 27(4):286-294, 2018).
在医疗保险和医疗补助服务中心的医院再入院率降低计划的背景下，医院无法控制的因素是否会影响再入院率仍存在激烈争论。本研究旨在评估贫困、种族和医院规模对超额再入院率的潜在影响，超过3000家医院参与了“医院比较”。通过贫困、种族（黑人人口百分比）和医院规模（出院人数）这三个地区和医院层面的因素，评估了五个符合条件的结果（包括髋关节和膝关节置换术）的超额再入院率之间的相关性。这些比率与种族的相关系数约为r = 0.2，始终大于与贫困的相关系数（r = 0 - 0.1），与规模的相关系数为r = 0至 - 0.5。髋关节和膝关节置换术有独特的发现：与贫困无相关性（r ≈ 0），变异性最大，与规模有强烈的单调性（r ≈ - 0.5）。西班牙裔人口百分比在二次分析中显示出可忽略不计的相关性。处罚评估和医院概况分析应考虑黑人人口比例高且髋关节和膝关节手术医院及医疗服务提供者数量少的地区。（《外科骨科进展杂志》27(4):286 - 294, 2018）
