Readmission Rates for Chronic Obstructive Pulmonary Disease Under the Hospital Readmissions Reduction Program: an Interrupted Time Series Analysis
Readmission Rates for Chronic Obstructive Pulmonary Disease Under the Hospital Readmissions Reduction Program: an Interrupted Time Series Analysis
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DOI：
10.1007/s11606-020-05958-0
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发表时间：
2020-06-17
影响因子：
5.7
通讯作者：
Ong, Michael K.
中科院分区：
文献类型：
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作者：
Buhr, Russell G.;Jackson, Nicholas J.;Ong, Michael K.
背景 随着再入院减少计划 (HRRP) 第一阶段的实施，心肌梗死 (AMI)、心力衰竭 (CHF) 和肺炎的再入院率有所下降。目前尚不清楚，慢性阻塞性肺疾病 (COPD) 的再入院率是否有所下降，这是 2014 年添加的 HRRP 条件。 目的 我们试图确定 HRRP 处罚是否会影响 Medicare、Medicaid 或私人保险患者中的 COPD 再入院率。设计我们分析了一个回顾性队列，评估了HRRP处罚实施期间的再入院情况（“HRRP前”2010年1月至2011年4月，“实施”2011年5月至2012年9月，“部分处罚”2012年10月至2014年9月，“全部处罚”2014年10月至2016年12月）。患者 我们评估了≥ 40 岁的患有 COPD 的出院患者与患有 HRRP 1 期疾病（AMI、CHF 和肺炎）或全国再入院数据库中的非 HRRP 残留诊断的患者。干预措施HRRP在此期间宣布并实施，形成了一个自然的实验。测量 我们计算了 30 天 COPD 与 HRRP 第一阶段和非 HRRP 再入院的双重差异 (DID)。主要结果 120 万医疗保险参保者的 COPD 出院情况与 2200 万非 HRRP 和 340 万 HRRP 第一阶段出院人员进行了比较。研究期间，慢性阻塞性肺病 (COPD) 再入院率从 19% 下降至 17%。这种降低显着大于非 HRRP 条件 (DID - 0.41%)，但不是 HRRP 第 1 阶段 (DID + 0.02%)。在私人受保人中观察到了平行趋势，与非 HRRP (DID - 0.83%) 相比显着减少，但 HRRP 第一阶段条件 (DID - 0.45%) 则没有显着减少。医疗补助没有显着减少（DID - 与非 HRRP 相比为 0.52%，与第一阶段条件相比 - 0.21%）。结论 在医疗保险中，与非 HRRP 对照相比，HRRP 实施与 COPD 再入院率降低相关，但与其他 HRRP 条件相比则不然。在商业保险中也观察到了类似的结果，但在医疗补助中却没有。针对具体情况的处罚可能不会比现有 HRRP 趋势进一步减少再入院率。
Background Hospital readmission rates decreased for myocardial infarction (AMI), heart failure (CHF), and pneumonia with implementation of the first phase of the Hospital Readmissions Reduction Program (HRRP). It is not established whether readmissions fell for chronic obstructive pulmonary disease (COPD), an HRRP condition added in 2014. Objective We sought to determine whether HRRP penalties influenced COPD readmissions among Medicare, Medicaid, or privately insured patients. Design We analyzed a retrospective cohort, evaluating readmissions across implementation periods for HRRP penalties ("pre-HRRP" January 2010-April 2011, "implementation" May 2011-September 2012, "partial penalty" October 2012-September 2014, and "full penalty" October 2014-December 2016). Patients We assessed discharged patients >= 40 years old with COPD versus those with HRRP Phase 1 conditions (AMI, CHF, and pneumonia) or non-HRRP residual diagnoses in the Nationwide Readmissions Database. Interventions HRRP was announced and implemented during this period, forming a natural experiment. Measurements We calculated differences-in-differences (DID) for 30-day COPD versus HRRP Phase 1 and non-HRRP readmissions. Key Results COPD discharges for 1.2 million Medicare enrollees were compared with 22 million non-HRRP and 3.4 million HRRP Phase 1 discharges. COPD readmissions decreased from 19 to 17% over the study. This reduction was significantly greater than non-HRRP conditions (DID - 0.41%), but not HRRP Phase 1 (DID + 0.02%). A parallel trend was observed in the privately insured, with significant reduction compared with non-HRRP (DID - 0.83%), but not HRRP Phase 1 conditions (DID - 0.45%). Non-significant reductions occurred in Medicaid (DID - 0.52% vs. non-HRRP and - 0.21% vs. Phase 1 conditions). Conclusions In Medicare, HRRP implementation was associated with reductions in COPD readmissions compared with non-HRRP controls but not versus other HRRP conditions. Parallel findings were observed in commercial insurance, but not in Medicaid. Condition-specific penalties may not reduce readmissions further than existing HRRP trends.