Adamson Alexander, Dodd James, Wilkinson Thomas, Calvert James M, Nava George W, Van Geffen Peter, Quint Jennifer K
School of Public Health, Imperial College London, London, UK.
Academic Respiratory Unit, University of Bristol, Bristol, UK.
BMJ Med. 2025 Aug 4;4(1):e001398. doi: 10.1136/bmjmed-2025-001398. eCollection 2025.
To assess whether meeting the NHS best practice tariff standard of care and its constituent elements for hospital admission of adults with acute asthma in England is associated with reduced 30 day and 90 day readmission to hospital.
Nationwide cohort study.
Secondary care in England, based on data collected from the 2022-23 National Respiratory Audit Programme adult asthma audit, linked with data from Hospital Episode Statistics, 1 April 2022 to 30 June 2023.
12 964 patients from 151 hospitals admitted with acute asthma to hospitals in England that took part in the National Respiratory Audit Programme and had their data entered, who were eligible for linkage with Hospital Episode Statistics data, were recorded as male or female sex, and were alive at discharge.
30 and 90 day hospital readmission for asthma or any cause. Association between readmission and meeting best practice tariff standard of care and its constituent elements, adjusted for potential confounders and including a clustering effect for hospital.
3627 (28.0%) patients were documented as having received the best practice tariff standard of care (a respiratory specialist review within 24 hours of admission and a discharge bundle with key good practice elements). 538 (4.1%) and 1077 (8.3%) patients were readmitted to hospital with asthma within 30 and 90 days, respectively. Receiving best practice tariff standard of care was not associated with either readmission (30 day asthma readmission adjusted odds ratio 0.88 (95% confidence interval (CI) 0.71 to 1.08); 90 day adjusted odds ratio 1.01 (0.87 to 1.17)), and nor was receiving a respiratory specialist review within 24 hours of arrival (30 day adjusted odds ratio 0.92 (0.76 to 1.10); 90 day adjusted odds ratio 1.01 (0.89 to 1.16)). Receiving a discharge bundle was associated with reduced readmission (30 day adjusted odds ratio 0.61 (95% CI 0.50 to 0.75), number needed to treat 68; 90 day adjusted odds ratio 0.77 (0.65 to 0.89), number needed to treat 67), as was receiving a respiratory specialist review at any point (30 day adjusted odds ratio 0.70 (95% CI 0.55 to 0.89), number needed to treat 75). 79.5% of participants who received a respiratory specialist review received a discharge bundle (8596/10 816) compared with 19.4% of those who did not receive a specialist review (417/2148).
In this study, components of the adult asthma discharge bundle were associated with reduced readmission to hospital for asthma. Best practice tariffs should be evidence based to improve quality of care and patient outcomes.
评估达到英国国家医疗服务体系（NHS）针对英格兰成年急性哮喘患者住院治疗的最佳实践收费标准及其构成要素，是否与30天和90天再入院率降低相关。
全国队列研究。
基于2022 - 23年国家呼吸审计项目成人哮喘审计收集的数据，以及2022年4月1日至2023年6月30日医院事件统计数据，对英格兰二级医疗进行研究。
来自151家医院的12964例因急性哮喘入院的患者，这些医院参与了国家呼吸审计项目并录入了数据，符合与医院事件统计数据关联条件，记录了性别，出院时存活。
哮喘或任何原因导致的30天和90天再入院。再入院与达到最佳实践收费标准及其构成要素之间的关联，对潜在混杂因素进行校正，并纳入医院聚类效应。
3627例（28.0%）患者被记录为接受了最佳实践收费标准的治疗（入院后24小时内进行呼吸专科评估以及包含关键良好实践要素的出院综合方案）。分别有538例（4.1%）和1077例（8.3%）患者在30天和90天内因哮喘再次入院。接受最佳实践收费标准的治疗与再入院均无关联（30天哮喘再入院校正比值比0.88（95%置信区间（CI）0.71至1.08）；90天校正比值比1.01（0.87至1.17）），入院后24小时内接受呼吸专科评估也无关联（30天校正比值比0.92（0.76至1.10）；90天校正比值比1.01（0.89至1.16））。接受出院综合方案与再入院率降低相关（30天校正比值比0.61（95%CI 0.50至0.75），需治疗人数68；90天校正比值比0.77（0.65至0.89），需治疗人数67），在任何时间接受呼吸专科评估也相关（30天校正比值比0.70（95%CI 0.55至0.89），需治疗人数75）。接受呼吸专科评估的参与者中有79.5%接受了出院综合方案（8596/10816），而未接受专科评估的参与者中这一比例为19.4%（417/2148）。
在本研究中，成人哮喘出院综合方案的组成部分与哮喘再入院率降低相关。最佳实践收费标准应以证据为基础，以提高医疗质量和患者结局。
