Preventable Admissions on a General Medicine Service: Prevalence, Causes and Comparison with AHRQ Prevention Quality Indicators-A Cross-Sectional Analysis
Preventable Admissions on a General Medicine Service: Prevalence, Causes and Comparison with AHRQ Prevention Quality Indicators-A Cross-Sectional Analysis
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DOI：
10.1007/s11606-016-3615-4
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发表时间：
2016-06-01
影响因子：
5.7
通讯作者：
Rothberg, Michael B.
中科院分区：
文献类型：
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作者：
Patel, Krishna K.;Vakharia, Nirav;Rothberg, Michael B.
可预防的入院率将很快公开报告，并用于计算基于绩效的报酬。目前评估可预防入院的方法，医疗保健研究和质量机构（AHRQ）可预防质量指标（PQI）率，从索赔数据中提取，最初设计用于评估人口水平的医疗服务。通过主治医生审查确定可预防入院的患病率和原因，并将其与PQI工具在确定可预防入院方面的性能进行比较。2013年12月1日至15日的连续住院病例。住院主治医生关于住院可预防性、主要影响因素和预防可行性的调查。对于相同的患者，应用PQI工具来确定索赔衍生的可预防入院率。医生对所有322例入院进行了评级，并将122例（38%）归类为可预防，其中31例（25%）为再入院。再入院比其他入院更有可能被评为可预防的（49%对35%，p = 0. 04）。应用AHRQ PQI方法确定了75例（23%）可预防的入院。31例住院（10%）被两种方法分类为可预防的，大多数被AHRQ PQI方法认为可预防的住院（44/78）被医生评估认为不可预防（K = 0.04）。在可预防的入院中，医生分配了54例（44%）患者因素，36例（30%）临床医生因素和32例（26%）系统因素。在开始PQI率用于按绩效付费计划之前，需要进一步研究。
Rates of preventable admissions will soon be publicly reported and used in calculating performance-based payments. The current method of assessing preventable admissions, the Agency of Healthcare Research and Quality (AHRQ) Preventable Quality Indicators (PQI) rate, is drawn from claims data and was originally designed to assess population-level access to care.To identify the prevalence and causes of preventable admissions by attending physician review and to compare its performance with the PQI tool in identifying preventable admissions.Cross-sectional survey.General medicine service at an academic medical center.Consecutive inpatient admissions from December 1-15, 2013.Survey of inpatient attending physicians regarding the preventability of the admissions, primary contributing factors and feasibility of prevention. For the same patients, the PQI tool was applied to determine the claims-derived preventable admission rate.Physicians rated all 322 admissions and classified 122 (38 %) as preventable, of which 31 (25 %) were readmissions. Readmissions were more likely to be rated preventable than other admissions (49 % vs. 35 %, p = 0.04). Application of the AHRQ PQI methodology identified 75 (23 %) preventable admissions. Thirty-one admissions (10 %) were classified as preventable by both methods, and the majority of admissions considered preventable by the AHRQ PQI method (44/78) were not considered preventable by physician assessment (K = 0.04). Of the preventable admissions, physicians assigned patient factors in 54 (44 %), clinician factors in 36 (30 %) and system factors in 32 (26 %).A large proportion of admissions to a general medicine service appeared preventable, but AHRQ's PQI tool was unable to identify these admissions. Before initiation of the PQI rate for use in pay-for-performance programs, further study is warranted.