Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
J Gen Intern Med. 2020 Dec;35(12):3581-3590. doi: 10.1007/s11606-020-05958-0. Epub 2020 Jun 17.
Hospital readmission rates decreased for myocardial infarction (AMI), heart failure (CHF), and pneumonia with implementation of the first phase of the Hospital Readmissions Reduction Program (HRRP). It is not established whether readmissions fell for chronic obstructive pulmonary disease (COPD), an HRRP condition added in 2014.
We sought to determine whether HRRP penalties influenced COPD readmissions among Medicare, Medicaid, or privately insured patients.
We analyzed a retrospective cohort, evaluating readmissions across implementation periods for HRRP penalties ("pre-HRRP" January 2010-April 2011, "implementation" May 2011-September 2012, "partial penalty" October 2012-September 2014, and "full penalty" October 2014-December 2016).
We assessed discharged patients ≥ 40 years old with COPD versus those with HRRP Phase 1 conditions (AMI, CHF, and pneumonia) or non-HRRP residual diagnoses in the Nationwide Readmissions Database.
HRRP was announced and implemented during this period, forming a natural experiment.
We calculated differences-in-differences (DID) for 30-day COPD versus HRRP Phase 1 and non-HRRP readmissions.
COPD discharges for 1.2 million Medicare enrollees were compared with 22 million non-HRRP and 3.4 million HRRP Phase 1 discharges. COPD readmissions decreased from 19 to 17% over the study. This reduction was significantly greater than non-HRRP conditions (DID - 0.41%), but not HRRP Phase 1 (DID + 0.02%). A parallel trend was observed in the privately insured, with significant reduction compared with non-HRRP (DID - 0.83%), but not HRRP Phase 1 conditions (DID - 0.45%). Non-significant reductions occurred in Medicaid (DID - 0.52% vs. non-HRRP and - 0.21% vs. Phase 1 conditions).
In Medicare, HRRP implementation was associated with reductions in COPD readmissions compared with non-HRRP controls but not versus other HRRP conditions. Parallel findings were observed in commercial insurance, but not in Medicaid. Condition-specific penalties may not reduce readmissions further than existing HRRP trends.
随着医院再入院率降低计划（HRRP）第一阶段的实施，心肌梗死（AMI）、心力衰竭（CHF）和肺炎的再入院率有所下降。但尚未确定 2014 年加入 HRRP 的慢性阻塞性肺疾病（COPD）的再入院率是否有所下降。
我们旨在确定 HRRP 处罚是否会影响医疗保险、医疗补助或私人保险患者的 COPD 再入院率。
我们分析了一个回顾性队列，评估了 HRRP 处罚的实施期间（“实施前”：2010 年 1 月至 2011 年 4 月；“实施中”：2011 年 5 月至 2012 年 9 月；“部分处罚”：2012 年 10 月至 2014 年 9 月；“全面处罚”：2014 年 10 月至 2016 年 12 月）的 COPD 再入院情况。
我们评估了年龄在 40 岁以上的 COPD 出院患者，与 HRRP 第一阶段的疾病（AMI、CHF 和肺炎）或全国再入院数据库中非 HRRP 剩余诊断的患者进行了比较。
在此期间宣布并实施了 HRRP，形成了一个自然实验。
我们计算了 30 天 COPD 与 HRRP 第一阶段和非 HRRP 再入院的差异。
对 120 万医疗保险参保者的 COPD 出院患者与 2200 万非 HRRP 和 340 万 HRRP 第一阶段出院患者进行了比较。研究期间，COPD 的再入院率从 19%下降到 17%。与非 HRRP 疾病相比，这一降幅显著更大（差异 -0.41%），但与 HRRP 第一阶段疾病相比，这一降幅并无显著差异（差异 +0.02%）。私人保险中也观察到了类似的趋势，与非 HRRP 相比，COPD 再入院率显著下降（差异 -0.83%），但与 HRRP 第一阶段疾病相比，这一降幅并无显著差异（差异 -0.45%）。医疗补助中则无显著降幅（差异 -0.52%，与非 HRRP 相比；差异 -0.21%，与 HRRP 第一阶段疾病相比）。
在医疗保险中，与非 HRRP 对照组相比，HRRP 的实施与 COPD 再入院率的降低相关，但与其他 HRRP 疾病相比并无显著差异。在商业保险中也观察到了类似的发现，但在医疗补助中则没有。针对特定疾病的处罚可能不会比现有的 HRRP 趋势进一步降低再入院率。
