Samarghandi Arash, Qayyum Rehan
Division of Hospital Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond, Virginia.
J Hosp Med. 2019 Sep 18;14:E25-E30. doi: 10.12788/jhm.3302.
Although the Hospital Readmission Reduction Program (HRRP) has reduced the 30-day readmission rates for patients with chronic obstructive pulmonary disease (COPD) across hospitals, the effect of HRRP on hospital mortality remains unknown. Therefore, we examined the association between hospital readmissions and mortality rates for patients discharged with acute exacerbation of COPD (AECOPD).
The all-cause hospital-specific 30-day risk-standardized mortality rate (RSMR) and the 30-day risk-standardized readmission rate (RSRR) for patients with COPD from 2010 to 2017 were obtained from the Hospital Compare website. Hospital service area (HSA) information was obtained from the Dartmouth Atlas of Healthcare. The longitudinal relationship between the mortality and readmission rates of a hospital was assessed using mixed linear models.
Of the 3,685 hospitals analyzed, the unadjusted mean RSMRs increased from 7.8% to 8.4% during the study period at a yearly rate of 0.13 (95% CI = 0.12 to 0.14; P < .001), whereas the mean RSRRs declined from 20.7% to 19.6%. When examined according to the baseline readmission rate and interaction with time, each 1% higher-than-baseline readmission rate was associated with a smaller increase in mortality rate by 0.015% (95% CI = -0.02 to -0.01; P < .0001). Inclusion of change in readmissions in the model showed that each 1% decrease in readmission rate was associated with 0.04% (95% CI = -0.01 to -0.06; P = .008) increase in mortality.
This hospital-level analysis of AECOPD showed that although the 30-day all-cause readmission rates declined, the mortality rates increased. Hospitals with lower readmission rates had higher mortality rates over time.
尽管医院再入院率降低计划（HRRP）已降低了各医院慢性阻塞性肺疾病（COPD）患者的30天再入院率，但HRRP对医院死亡率的影响仍不明确。因此，我们研究了因慢性阻塞性肺疾病急性加重（AECOPD）出院患者的医院再入院率与死亡率之间的关联。
从医院比较网站获取2010年至2017年COPD患者的全因医院特定30天风险标准化死亡率（RSMR）和30天风险标准化再入院率（RSRR）。医院服务区（HSA）信息来自达特茅斯医疗地图集。使用混合线性模型评估医院死亡率和再入院率之间的纵向关系。
在分析的3685家医院中，研究期间未调整的平均RSMR从7.8%上升至8.4%，年增长率为0.13（95%CI=0.12至0.14；P<.001），而平均RSRR从20.7%降至19.6%。根据基线再入院率并结合时间进行分析时，再入院率比基线每高1%，死亡率的增幅就会小0.015%（95%CI=-0.02至-0.01；P<.0001）。模型中纳入再入院率的变化后显示，再入院率每降低1%，死亡率就会增加0.04%（95%CI=-0.01至-0.06；P=.008）。
这项针对AECOPD的医院层面分析表明，尽管30天全因再入院率有所下降，但死亡率却有所上升。随着时间的推移，再入院率较低的医院死亡率较高。
