审查退伍军人健康管理局 30 天再入院率和医院档案的效用。

Examining the Utility of 30-day Readmission Rates and Hospital Profiling in the Veterans Health Administration.

机构信息

Department of Medicine, University of California, San Francisco, California.

Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.

出版信息

J Hosp Med. 2019 May;14(5):266-271. doi: 10.12788/jhm.3155.

DOI:10.12788/jhm.3155

PMID:30794141

Abstract

BACKGROUND

The Veterans Health Administration (VA) reports hospital-specific 30-day risk-standardized readmission rates (RSRRs) using CMS-derived models.

OBJECTIVE

The aim of this study was to examine and describe the interfacility variability of 30-day RSRRs for acute myocardial infarction (AMI), heart failure (HF), and pneumonia as a means to assess its utility for VA quality improvement and hospital comparison.

RESEARCH DESIGN

A retrospective analysis of VA and Medicare claims data using one-year (2012) and three-year (2010-2012) data given their use for quality improvement or for hospital comparison, respectively.

SUBJECTS

This study included 3,571 patients hospitalized for AMI at 56 hospitals, 10,609 patients hospitalized for HF at 102 hospitals, and 10,191 patients hospitalized for pneumonia at 106 hospitals.

MEASURES

Hospital-specific 30-day RSRRs for AMI, HF, and pneumonia hospitalizations were calculated using hierarchical generalized linear models.

RESULTS

Of 164 qualifying VA hospitals, 56 (34%), 102 (62%), and 106 (64%) qualified for analysis based on CMS criteria for AMI, HF, and pneumonia cohorts, respectively. Using 2012 data, we found that two hospitals (2%) had CHF RSRRs worse than the national average (+95% CI), whereas no hospital demonstrated worse-than-average risk-stratified readmission Rate (RSRR; +95% CI) for AMI or pneumonia. After increasing the number of facility admissions by combining three years of data, we found that four (range: 3.5%-5.3%) hospitals had RSRRs worse than the national average (+95% CI) for all three conditions.

CONCLUSIONS

The Centers for Medicare and Medicaid Services-derived 30-day readmission measure may not be a useful measure to distinguish VA interfacility performance or drive quality improvement given the low facility-level volume of such readmissions.

摘要

背景

退伍军人健康管理局（VA）使用 CMS 衍生模型报告医院特定的 30 天风险标准化再入院率（RSRR）。

目的

本研究旨在检查和描述急性心肌梗死（AMI）、心力衰竭（HF）和肺炎的 30 天 RSRR 的医院间变异性，以评估其在 VA 质量改进和医院比较中的效用。

研究设计

使用 VA 和 Medicare 索赔数据进行回顾性分析，分别使用一年（2012 年）和三年（2010-2012 年）的数据，因为它们分别用于质量改进或医院比较。

受试者

这项研究包括 56 家医院的 3571 名 AMI 住院患者、102 家医院的 10609 名 HF 住院患者和 106 家医院的 10191 名肺炎住院患者。

测量方法

使用分层广义线性模型计算 AMI、HF 和肺炎住院的医院特异性 30 天 RSRR。

结果

在 164 家符合条件的 VA 医院中，根据 CMS 标准，分别有 56 家（34%）、102 家（62%）和 106 家（64%）符合 AMI、HF 和肺炎队列的分析条件。使用 2012 年的数据，我们发现两家医院（2%）的 CHF RSRR 低于全国平均水平（+95%置信区间），而没有一家医院的风险分层再入院率（RSRR；+95%置信区间）低于 AMI 或肺炎。在增加三年数据的设施入院人数后，我们发现四家（范围：3.5%-5.3%）医院的所有三种情况的 RSRR 均低于全国平均水平（+95%置信区间）。