Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care.
Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care.
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DOI：
10.1377/hlthaff.2016.0205
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发表时间：
2016-10-01
期刊：
影响因子：
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通讯作者：
Romano PS
中科院分区：
文献类型：
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作者：
Chin DL;Bang H;Manickam RN;Romano PS
美国的公共报告和支付计划已经将30天再入院作为医院间护理质量差异的指标，尽管支持这一间隔的证据有限。我们研究了四个州65岁及以上的医疗保险患者在医院层面非计划性住院再入院的风险标准化30天风险，这些患者有三种情况：急性心肌梗死、心力衰竭和肺炎。再入院风险中捕获的医院级质量信号在出院后第一天最高，并迅速下降，直到第七天达到最低点，如集群内相关系数下降所示。在各州和诊断中也看到了类似的模式。质量信号的快速衰减表明，大多数出院后第七天后的再入院是由医院无法控制的社区和家庭因素造成的。更短的间隔时间为7天或更少，可能会提高再入院的准确性和公平性，作为衡量医院质量的公共责任。
Public reporting and payment programs in the United States have embraced thirty-day readmissions as an indicator of between-hospital variation in the quality of care, despite limited evidence supporting this interval. We examined risk-standardized thirty-day risk of unplanned inpatient readmission at the hospital level for Medicare patients ages sixty-five and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. The hospital-level quality signal captured in readmission risk was highest on the first day after discharge and declined rapidly until it reached a nadir at seven days, as indicated by a decreasing intracluster correlation coefficient. Similar patterns were seen across states and diagnoses. The rapid decay in the quality signal suggests that most readmissions after the seventh day postdischarge were explained by community- and household-level factors beyond hospitals’ control. Shorter intervals of seven or fewer days might improve the accuracy and equity of readmissions as a measure of hospital quality for public accountability.