Department of Social Medicine, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan.
Int J Environ Res Public Health. 2021 Jul 17;18(14):7624. doi: 10.3390/ijerph18147624.
Previous studies indicated that optimal care for pneumonia during hospitalization might reduce the risk of in-hospital mortality and subsequent readmission. This study was a retrospective observational study using Japanese administrative claims data from April 2010 to March 2019. We analyzed data from 167,120 inpatients with pneumonia ≥15 years old in the benchmarking project managed by All Japan Hospital Association. Hospital-level risk-adjusted ratios of 30-day readmission for pneumonia were calculated using multivariable logistic regression analyses. The Spearman's correlation coefficient was used to assess the correlation in each consecutive period. In the analysis using complete 9-year data including 54,756 inpatients, the hospital standardized readmission ratios (HSRRs) showed wide variation among hospitals and improvement trend (r = -0.18, = 0.03). In the analyses of trends in each consecutive period, the HSRRS were positively correlated between '2010-2012' and '2013-2015' (r = 0.255, = 0.010), and '2013-2015' and '2016-2018' (r = 0.603, < 0.001). This study denoted the HSRRs for pneumonia could be calculated using Japanese administrative claims data. The HSRRs significantly varied among hospitals with comparable case-mix, and could relatively evaluate the quality of preventing readmission including long-term trends. The HSRRs can be used as yet another measure to help improve quality of care over time if other indicators are examined in parallel.
先前的研究表明，优化住院期间肺炎的治疗可能会降低院内死亡率和随后再入院的风险。本研究使用 2010 年 4 月至 2019 年 3 月期间日本全国医院协会管理的基准项目中的行政索赔数据进行了回顾性观察研究。我们分析了基准项目中年龄≥15 岁的 167120 例肺炎住院患者的数据。使用多变量逻辑回归分析计算肺炎 30 天再入院的医院风险调整比率。使用 Spearman 相关系数评估每个连续时期的相关性。在包括 54756 例患者的完整 9 年数据的分析中，医院标准化再入院率（HSRR）在医院之间存在很大差异且呈上升趋势（r=-0.18， =0.03）。在每个连续时期趋势的分析中，“2010-2012”和“2013-2015”（r=0.255， =0.010）以及“2013-2015”和“2016-2018”（r=0.603， <0.001）之间的 HSRR 呈正相关。本研究表明，使用日本行政索赔数据可以计算肺炎的 HSRR。HSRR 在具有可比病例组合的医院之间存在显著差异，可以相对评估包括长期趋势在内的预防再入院的质量。如果同时检查其他指标，HSRR 可作为帮助提高治疗质量的另一个指标。
