Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (S.E., J.M., H.M.K., Y.W.).
Section of Cardiovascular Medicine (H.M.K., Y.W.), Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Circ Cardiovasc Qual Outcomes. 2023 Jul;16(7):e009573. doi: 10.1161/CIRCOUTCOMES.122.009573. Epub 2023 Jul 18.
Hospitals with high mortality and readmission rates for patients with heart failure (HF) might also perform poorly in other quality concepts. We sought to evaluate the association between hospital performance on mortality and readmission with hospital performance rates of safety adverse events.
This cross-sectional study linked the 2009 to 2019 patient-level adverse events data from the Medicare Patient Safety Monitoring System, a randomly selected medical records-abstracted patient safety database, to the 2005 to 2016 hospital-level HF-specific 30-day all-cause mortality and readmissions data from the United States Centers for Medicare & Medicaid Services. Hospitals were classified to one of 3 performance categories based on their risk-standardized 30-day all-cause mortality and readmission rates: better (both in <25th percentile), worse (both >75th percentile), and average (otherwise). Our main outcome was the occurrence (yes/no) of one or more adverse events during hospitalization. A mixed-effect model was fit to assess the relationship between a patient's risk of having adverse events and hospital performance categories, adjusted for patient and hospital characteristics.
The study included 39 597 patients with HF from 3108 hospitals, of which 252 hospitals (8.1%) and 215 (6.9%) were in the better and worse categories, respectively. The rate of patients with one or more adverse events during a hospitalization was 12.5% (95% CI, 12.1-12.8). Compared with patients admitted to better hospitals, patients admitted to worse hospitals had a higher risk of one or more hospital-acquired adverse events (adjusted risk ratio, 1.24 [95% CI, 1.06-1.44]).
Patients admitted with HF to hospitals with high 30-day all-cause mortality and readmission rates had a higher risk of in-hospital adverse events. There may be common quality issues among these 3 measure concepts in these hospitals that produce poor performance for patients with HF.
心力衰竭（HF）患者死亡率和再入院率较高的医院，在其他质量指标方面的表现可能也较差。我们试图评估医院在死亡率和再入院率方面的表现与医院在安全不良事件方面的表现率之间的关联。
本横断面研究将 2009 年至 2019 年医疗保险患者安全监测系统的患者水平不良事件数据（这是一个随机选择的病历摘要患者安全数据库）与美国医疗保险和医疗补助服务中心 2005 年至 2016 年 HF 特定 30 天全因死亡率和再入院率的医院水平数据进行了链接。根据其风险标准化 30 天全因死亡率和再入院率，将医院分为 3 个绩效类别之一：更好（均<25 百分位）、更差（均>75 百分位）和平均（其他）。我们的主要结局是住院期间发生（是/否）一次或多次不良事件。使用混合效应模型评估患者发生不良事件的风险与医院绩效类别之间的关系，并对患者和医院特征进行了调整。
研究纳入了 3108 家医院的 39597 例 HF 患者，其中 252 家（8.1%）和 215 家（6.9%）医院分别属于更好和更差类别。住院期间发生一次或多次不良事件的患者比例为 12.5%（95%CI，12.1-12.8）。与入住更好医院的患者相比，入住更差医院的患者发生一次或多次医院获得性不良事件的风险更高（调整风险比，1.24[95%CI，1.06-1.44]）。
因 HF 入院的患者入住 30 天全因死亡率和再入院率较高的医院，发生院内不良事件的风险更高。这些医院的这 3 个衡量概念可能存在共同的质量问题，导致 HF 患者的表现不佳。
