Wasfy Jason H, Hidrue Michael K, Ngo Jacqueline, Tanguturi Varsha K, Cafiero-Fonseca Elizabeth T, Thompson Ryan W, Johnson Natalie, McDermott Susan T, Singh Jagmeet P, Del Carmen Marcela G, Ferris Timothy G
Cardiology Division, Department of Medicine (J.H.W., V.K.T., S.T.M., J.P.S.), Massachusetts General Hospital, Harvard Medical School, Boston.
Massachusetts General Physicians Organization, Boston (J.H.W., M.K.H., J.N., M.G.d.C., T.G.F.).
Circ Cardiovasc Qual Outcomes. 2020 May;13(5):e006043. doi: 10.1161/CIRCOUTCOMES.119.006043. Epub 2020 May 12.
Reducing hospital readmission after acute myocardial infarction (AMI) has the potential to both improve quality and reduce costs. As such, readmission after AMI has been a target of financial penalties through Medicare. However, substantial concern exists about potential adverse effects and efficacious readmission-reduction strategies are not well validated.
We started an AMI readmissions reduction program in November 2017. Between July 2016 and February 2019, hospital billing data were queried to detect all inpatient hospitalizations at the Massachusetts General Hospital for AMI. Thirty-day readmission was identified through hospital billing data, and mortality was extracted from our electronic health record. The data set was merged with claims data for patients in accountable care organizations to detect readmission at other hospitals. We performed segmented linear regression, adjusting for secular trend and case mix, to assess the independent association of our program on both outcome variables. After inclusion and exclusion criteria were applied, the study population included 2020 patients. The overall 30-day readmission rate was higher before the intervention than after the intervention (15.5% versus 10.7%, =0.002). The overall 30-day mortality rate was similar in both time periods (1.8% versus 1.4%, =0.457). The program was associated with initial reduction in 30-day readmission (-9.8%, =0.0002) and 30-day mortality (-2.6%, =0.041). The program did not change trend in 30-day readmission (+0.19% readmissions/mo, =0.554) and trend in 30-day mortality (-0.21% deaths/mo, =0.119).
An AMI readmissions reduction program that increases outpatient and emergency department (ED) access to cardiology care is associated with reduced 30-day readmission and 30-day mortality. Similar statistical techniques can be used to conduct a rigorous, mechanistic program evaluation of other quality improvement initiatives.
降低急性心肌梗死（AMI）后的医院再入院率有可能提高医疗质量并降低成本。因此，AMI后的再入院已成为医疗保险实施经济处罚的目标。然而，人们对潜在的不良影响存在重大担忧，且有效的再入院率降低策略尚未得到充分验证。
我们于2017年11月启动了一项AMI再入院率降低计划。在2016年7月至2019年2月期间，查询医院计费数据以检测麻省总医院所有因AMI住院的患者。通过医院计费数据确定30天再入院情况，并从我们的电子健康记录中提取死亡率。该数据集与负责医疗组织中患者的理赔数据合并，以检测其他医院的再入院情况。我们进行了分段线性回归，对长期趋势和病例组合进行调整，以评估我们的计划与两个结果变量之间的独立关联。应用纳入和排除标准后，研究人群包括2020例患者。干预前的总体30天再入院率高于干预后（15.5%对10.7%，P=0.002）。两个时间段的总体30天死亡率相似（1.8%对1.4%，P=0.457）。该计划与30天再入院率的初步降低（-9.8%，P=0.0002）和30天死亡率的降低（-2.6%，P=0.041）相关。该计划未改变30天再入院率的趋势（每月再入院率增加0.19%，P=0.554）和30天死亡率的趋势（每月死亡率降低0.21%，P=0.119）。
一项增加门诊和急诊科获得心脏病护理机会的AMI再入院率降低计划与30天再入院率和30天死亡率的降低相关。类似的统计技术可用于对其他质量改进举措进行严格的、基于机制的计划评估。
