Zhao Stephanie, Kendall Jamil, Johnson Alicia J, Sampson Alicia A G, Kagan Ryland
School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
Arthroplast Today. 2021 May 17;9:73-77. doi: 10.1016/j.artd.2021.04.002. eCollection 2021 Jun.
In 2014, the Affordable Care Act Hospital Readmissions Reduction Program began penalizing hospitals for excessive readmission rates 30 days after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Various data sets with nonstandardized validation processes report readmission data, which may provide conflicting outcome values for the same patient populations.
We queried 4 separate data sets: the American Joint Replacement Registry, Centers for Medicare and Medicaid Services billing data, the Vizient data set, and an advanced analytics integration (Cognos) report from our electronic medical record. We identified 2763 patients who underwent primary TKA and THA at a single academic medical center from June 2016 to June 2019. We then matched 613 surgery encounters in all 4 databases. Our primary outcome metric was 30-day readmissions. Fleiss' Kappa was used to measure agreement among the different data sets.
Of the 613 THA and TKA patients, there were 45 (7.3%) readmissions noted. Data collected from the Centers for Medicare and Medicaid Services flagged 41 (6.7%) readmissions, Vizient flagged 11 (1.8%) readmissions, and the American Joint Replacement Registry and Cognos report both flagged 6 (0.98%) readmissions each. None of the readmissions were identified by all 4 data sets. There was significant disagreement among data sets using Fleiss' Kappa (kappa = -0.1318, = .03).
There is disagreement in readmission rates in databases receiving the same patient data after THA and TKA. Care must be taken to establish standard validation processes and reporting methods and scrutiny applied when interpreting readmission rates from various data sets.
2014年，《平价医疗法案》医院再入院率降低计划开始对全髋关节置换术（THA）和全膝关节置换术（TKA）后30天内再入院率过高的医院进行处罚。各种数据集采用非标准化的验证流程来报告再入院数据，这可能会为同一患者群体提供相互矛盾的结果值。
我们查询了4个独立的数据集：美国关节置换登记处、医疗保险和医疗补助服务中心的计费数据、Vizient数据集以及我们电子病历中的高级分析集成（Cognos）报告。我们确定了2763例在2016年6月至2019年6月期间于一家学术医疗中心接受初次TKA和THA手术的患者。然后我们在所有4个数据库中匹配了613次手术病例。我们的主要结局指标是30天再入院率。使用Fleiss' Kappa来衡量不同数据集之间的一致性。
在613例THA和TKA患者中，有45例（7.3%）被记录为再入院。医疗保险和医疗补助服务中心收集的数据标记了41例（6.7%）再入院病例，Vizient标记了11例（1.8%）再入院病例，美国关节置换登记处和Cognos报告均各自标记了6例（0.98%）再入院病例。没有一个再入院病例被所有4个数据集识别出来。使用Fleiss' Kappa分析发现各数据集之间存在显著差异（kappa = -0.1318，P = .03）。
在接受相同患者数据的数据库中，THA和TKA后的再入院率存在差异。在解释来自各种数据集的再入院率时，必须谨慎建立标准的验证流程和报告方法，并进行仔细审查。
