Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine.
Office of Biostatistics.
Am J Respir Crit Care Med. 2021 Feb 15;203(4):437-446. doi: 10.1164/rccm.202002-0310OC.
Implementation of the Hospital Readmissions Reduction Program (HRRP) following discharge of patients with chronic obstructive pulmonary disease (COPD) has led to a reduction in 30-day readmissions with unknown effects on postdischarge mortality. To examine the association of HRRP with 30-day hospital readmission and 30-day postdischarge mortality rate in patients after discharge from COPD hospitalization. Retrospective cohort study of readmission and mortality rates in a national cohort ( = 4,587,542) of admissions of Medicare fee-for-service beneficiaries 65 years or older with COPD from 2006 to 2017. Data were analyzed for three nonoverlapping periods based on implementation of the HRRP specific to COPD: ) preannouncement (December 2006 to March 2010), ) announcement (April 2010 to August 2014), and ) implementation (October 2014 to November 2017). The 30-day readmission rate decreased from 20.54% in the preannouncement period (December 2006 to July 2008) to 18.74% in the implementation period (May 2016 to November 2017). The 30-day risk-standardized postdischarge mortality rates were 6.91%, 6.59%, and 7.30% for the preannouncement, announcement, and implementation periods, respectively. Generalized estimating equations analyses estimated an additional 1,196 deaths (October 2014 to April 2016) and 3,858 deaths (May 2016 to November 2017) during the HRRP implementation period. We found a reduction in 30-day all-cause readmission rate during the implementation period compared with the preannouncement phase. HRRP implementation was also associated with a significant increase in 30-day mortality after discharge from COPD hospitalization. Additional research is necessary to confirm our findings and understand the factors contributing to increased mortality in patients with COPD in the HRRP implementation period.
实施慢性阻塞性肺疾病（COPD）患者出院后减少再入院计划（HRRP）导致 30 天再入院率降低，但对出院后死亡率的影响尚不清楚。本研究旨在探讨 HRRP 与 COPD 住院患者出院后 30 天内医院再入院率和 30 天死亡率之间的关系。本研究是一项回顾性队列研究，纳入了 Medicare 按服务收费计划 65 岁及以上 COPD 患者的全国队列（n=4587542），这些患者在 2006 年至 2017 年期间住院。根据 HRRP 针对 COPD 的具体实施情况，将数据分为三个非重叠时期进行分析：）预告期（2006 年 12 月至 2010 年 3 月）、）宣布期（2010 年 4 月至 2014 年 8 月）和）实施期（2014 年 10 月至 2017 年 11 月）。30 天再入院率从预告期的 20.54%（2006 年 12 月至 2008 年 7 月）降至实施期的 18.74%（2016 年 5 月至 2017 年 11 月）。预告期、宣布期和实施期的 30 天风险标准化出院后死亡率分别为 6.91%、6.59%和 7.30%。广义估计方程分析估计，在 HRRP 实施期间，还额外增加了 1196 例（2014 年 10 月至 2016 年 4 月）和 3858 例（2016 年 5 月至 2017 年 11 月）死亡。与预告期相比，在实施期内，30 天全因再入院率降低。HRRP 的实施与 COPD 住院患者出院后 30 天死亡率的显著增加有关。需要进一步的研究来证实我们的发现，并了解在 HRRP 实施期间 COPD 患者死亡率增加的因素。
