Division of Research, Kaiser Permanente Northern California, Oakland, California; and.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Ann Am Thorac Soc. 2021 Sep;18(9):1506-1513. doi: 10.1513/AnnalsATS.202007-786OC.
In August 2013, the Hospital Readmission Reduction Program announced financial penalties on hospitals with higher than expected risk-adjusted 30-day readmission rates for Medicare beneficiaries hospitalized for chronic obstructive pulmonary disease (COPD) exacerbation. In October 2014, penalties were imposed. We hypothesized that penalties would be associated with decreased readmissions after COPD hospitalizations. To determine whether the announcement and enactment of financial penalties for COPD were associated with decreases in hospital readmissions for COPD. We used data from California's Office of Statewide Health Planning and Development to examine unplanned 30-day all-cause and COPD-related readmissions after COPD hospitalization. The preannouncement period was January 2010 to July 2013. The postannouncement period was August 2013 to September 2014. The postenactment period was October 2014 to December 2017. Using interrupted time series, we investigated the immediate change after the intervention (level change) and differences in the preintervention and postintervention trends (slope change). We identified 333,429 index hospitalizations for COPD from 449 California hospitals. Overall, 69% of patients had Medicare insurance. For all-cause readmissions, the level change at announcement was 0.16% (95% confidence interval [CI], -1.07 to 1.38; = 0.80); the change in slope between preannouncement and postannouncement periods was -0.01% (95% CI, -0.15 to 0.13; = 0.92). The level change at enactment was 0.29% (95% CI, -1.11 to 1.69; = 0.68); the change in slope between postannouncement and postenactment was 0.04% (95% CI, -0.10 to 0.18; = 0.57). For patients with COPD-related readmissions, the level change at the time of the announcement was 0.09% (95% CI, -0.68 to 0.85; = 0.83); the change in slope was 0.003% (95% CI, -0.08 to 0.09; = 0.94). The level change at the time of the enactment was 0.22% (95% CI, -0.69 to 1.12; = 0.64); the change in slope was -0.02% (95% CI, -0.10 to 0.07; = 0.72). We did not detect decreases in either all-cause or COPD-related readmission rates at either time point. Although this would suggest that the Hospital Readmission Reduction Program penalty was ineffective for COPD, COPD readmissions had decreased at an earlier time point (October 2012) when penalties were announced for conditions other than COPD. Based on this, we believe early, broad interventions decreased readmissions, such that no difference was seen at this later time points despite institution of COPD-specific penalties.
2013 年 8 月，医院再入院率降低计划对慢性阻塞性肺疾病（COPD）加重住院的 Medicare 受益人的 30 天风险调整再入院率高于预期的医院实施财务处罚。2014 年 10 月开始实施处罚。我们假设处罚将与 COPD 住院后再入院率降低相关。
为了确定 COPD 的财务处罚的宣布和实施是否与 COPD 患者的医院再入院率降低有关。我们使用加利福尼亚州全州卫生规划和发展办公室的数据，研究了 COPD 住院后 30 天内的非计划性全因和 COPD 相关再入院。预告前阶段为 2010 年 1 月至 2013 年 7 月。预告后阶段为 2013 年 8 月至 2014 年 9 月。预告后阶段为 2014 年 10 月至 2017 年 12 月。使用中断时间序列，我们研究了干预后的即时变化（水平变化）和干预前后趋势的差异（斜率变化）。
我们从加利福尼亚州的 449 家医院确定了 333429 例 COPD 指数住院。总体而言，69%的患者拥有医疗保险。对于全因再入院，预告时的水平变化为 0.16%（95%置信区间[CI]，-1.07 至 1.38； = 0.80）；预告前和预告后期间的斜率变化为-0.01%（95%CI，-0.15 至 0.13； = 0.92）。实施时的水平变化为 0.29%（95%CI，-1.11 至 1.69； = 0.68）；预告后和预告后阶段的斜率变化为 0.04%（95%CI，-0.10 至 0.18； = 0.57）。对于 COPD 相关再入院患者，预告时的水平变化为 0.09%（95%CI，-0.68 至 0.85； = 0.83）；斜率变化为 0.003%（95%CI，-0.08 至 0.09； = 0.94）。实施时的水平变化为 0.22%（95%CI，-0.69 至 1.12； = 0.64）；斜率变化为-0.02%（95%CI，-0.10 至 0.07； = 0.72）。
我们没有发现全因或 COPD 相关再入院率在任何一个时间点都有下降。尽管这表明医院再入院率降低计划的处罚对 COPD 无效，但 COPD 再入院率在更早的时候（2012 年 10 月）就已经下降，当时除 COPD 以外的其他疾病的处罚就已经公布。基于此，我们认为早期、广泛的干预措施降低了再入院率，因此尽管对 COPD 实施了具体的处罚，但在这个较晚的时间点没有看到差异。
