利用近乎实时的理赔数据及时估算 Medicare 急性心肌梗死、心力衰竭或肺炎患者的入院率、再入院率和观察留观率。
Timely estimation of National Admission, readmission, and observation-stay rates in medicare patients with acute myocardial infarction, heart failure, or pneumonia using near real-time claims data.
机构信息
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, USA.
出版信息
BMC Health Serv Res. 2020 Aug 10;20(1):733. doi: 10.1186/s12913-020-05611-w.
BACKGROUND
To estimate, prior to finalization of claims, the national monthly numbers of admissions and rates of 30-day readmissions and post-discharge observation-stays for Medicare fee-for-service beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure (HF), or pneumonia.
METHODS
The centers for Medicare & Medicaid Services (CMS) Integrated Data Repository, including the Medicare beneficiary enrollment database, was accessed in June 2015, February 2017, and February 2018. We evaluated patterns of delay in Medicare claims accrual, and used incomplete, non-final claims data to develop and validate models for real-time estimation of admissions, readmissions, and observation stays.
RESULTS
These real-time reporting models accurately estimate, within 2 months from admission, the monthly numbers of admissions, 30-day readmission and observation-stay rates for patients with AMI, HF, or pneumonia.
CONCLUSIONS
This work will allow CMS to track the impact of policy decisions in real time and enable hospitals to better monitor their performance nationally.
背景
在最终确定索赔之前，估算医疗保险按服务收费受益人的急性心肌梗死（AMI）、心力衰竭（HF）或肺炎住院患者的 30 天再入院率和出院后观察期入住率的全国月度人数。
方法
2015 年 6 月、2017 年 2 月和 2018 年 2 月，我们访问了医疗保险和医疗补助服务中心（CMS）综合数据存储库，包括医疗保险受益人的注册数据库。我们评估了医疗保险索赔累积延迟的模式，并使用不完整的非最终索赔数据来开发和验证实时估算入院、再入院和观察期入住的模型。
结果
这些实时报告模型能够准确估计，在入院后 2 个月内，AMI、HF 或肺炎患者的月度入院人数、30 天再入院率和观察期入住率。
结论
这项工作将使 CMS 能够实时跟踪政策决策的影响，并使医院能够更好地在全国范围内监测其绩效。
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