Benjenk Ivy, Shields Morgan, Chen Jie
School of Public Health, University of Maryland, College Park (Benjenk, Chen); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Shields).
Psychiatr Serv. 2020 Oct 1;71(10):1031-1038. doi: 10.1176/appi.ps.201900360. Epub 2020 Aug 25.
Since late 2012, the Medicare Inpatient Psychiatric Facility Quality Reporting (IPFQR) program of the Centers for Medicare and Medicaid Services (CMS) has required inpatient psychiatric facilities to collect and publicly report a suite of quality measures. This study explored the association between facility-level 30-day risk-adjusted all-cause readmission (medical or psychiatric) after psychiatric hospitalization (READM-30-IPF) and care coordination process measures in the IPFQR program.
The study used publicly reported IPFQR facility-level performance data of the Hospital Compare Web site for 1,343 inpatient psychiatric facilities, reflecting performance from July 2015 to June 2017. The authors used a cross-sectional design and linear regression models controlling for hospital and community characteristics and using state as fixed effect.
The mean±SD facility-level READM-30-IPF was 20%±3%, with substantial variation by facility type, ownership status, rurality, and percentage of racial-ethnic minority residents in the county. Regression results showed that facilities with performance in the top tercile on the measure of 7-day mental health follow-up after discharge had readmission rates significantly lower than facilities in the bottom tercile (coefficient=-0.58, p<0.01), although the magnitude of this difference was small. READM-30-IPF, however, did not vary by facilities' performance on measures of discharge plan creation and transmission.
Results suggest that facilities have substantial opportunities to reduce readmissions after psychiatric hospitalization. The association between hospital performance on care coordination process measures and the all-cause readmission measure currently included in the IPFQR program was minimal. The CMS should evaluate whether the IPFQR measures adequately capture compliance with evidence-based processes and desired outcomes.
自2012年末起，医疗保险和医疗补助服务中心（CMS）的医疗保险住院精神科机构质量报告（IPFQR）计划要求住院精神科机构收集并公开报告一系列质量指标。本研究探讨了精神科住院后机构层面30天风险调整全因再入院（医疗或精神科）（READM-30-IPF）与IPFQR计划中的护理协调过程指标之间的关联。
该研究使用了医院比较网站公开报告的1343家住院精神科机构的IPFQR机构层面绩效数据，反映2015年7月至2017年6月的绩效。作者采用横断面设计和线性回归模型，控制医院和社区特征，并将州作为固定效应。
机构层面READM-30-IPF的均值±标准差为20%±3%，因机构类型、所有权状态、农村地区以及县内种族少数族裔居民百分比而存在显著差异。回归结果显示，出院后7天心理健康随访指标表现处于前三分位的机构，其再入院率显著低于处于后三分位的机构（系数=-0.58，p<0.01），尽管这种差异的幅度较小。然而，READM-30-IPF并未因机构在出院计划制定和传递指标上的表现而有所不同。
结果表明，机构在降低精神科住院后的再入院率方面有很大机会。护理协调过程指标的医院表现与IPFQR计划目前纳入的全因再入院指标之间的关联极小。CMS应评估IPFQR指标是否充分反映了对循证流程和预期结果的遵循情况。
