Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act.
Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act.
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DOI：
10.1016/j.amjmed.2018.06.013
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发表时间：
2018-11
期刊：
影响因子：
--
通讯作者：
Krumholz HM
中科院分区：
文献类型：
--
作者：
Angraal S;Khera R;Zhou S;Wang Y;Lin Z;Dharmarajan K;Desai NR;Bernheim SM;Drye EE;Nasir K;Horwitz LI;Krumholz HM
不直接属于医院再入院减少计划（HRRP）范围的患者群体和条件的再入院率的时间变化可以帮助评估降低再入院率的努力是否超出了目标患者和条件。使用全国再入院数据库（2010-2015），我们评估了3种HRRP疾病（急性心肌梗死、心力衰竭、肺炎）中的1种或HRRP未针对的疾病的全因再入院率趋势，这些疾病是按年龄组（≥65岁或<65岁）和支付者（医疗保险、医疗补助或私人保险）定义的年龄保险组。在年龄≥65岁的人群中，医疗保险、医疗补助和私人保险覆盖人群的急性心肌梗死再入院率逐年下降（风险调整优势比[OR; 95%置信区间]，医疗保险患者中为0.94 [0.94-0.95]，医疗补助患者中为0.93 [0.90-0.97]，在有私人保险的患者中，0.95 [0.93-0.97]）;心力衰竭（3名支付者的OR分别为0.96 [0.96-0.97]、0.96 [0.94-0.98]和0.97 [0.96-0.99]）和肺炎（OR分别为0.96 [0.96-0.97]、0.94 [0.92-0.96]和0.96 [0.95-0.97]）。年龄<65岁的急性心肌梗死患者的再入院率也有所下降（OR：Medicare 0.97 [0.96-0.98]，Medicaid 0.94 [0.92-0.95]和私人保险0.93 [0.92-0.94]），心力衰竭（3名支付者的OR分别为0.98 [0.97-0.98]：0.96 [0.96-0.97]和0.97 [0.95-0.98]）和肺炎（OR分别为0.98 [0.97-0.99]、0.98 [0.97 - 0.99]和0.98 [0.97-1.00]）。此外，非目标条件的再入院率显著下降。似乎有一个系统的改善，在再入院率的病人群体以外的人口收费服务，老年人，医疗保险受益人包括在HRRP。
Temporal changes in the readmission rates for patient groups and conditions that were not directly under the purview of the Hospital Readmissions Reduction Program (HRRP) can help assess whether efforts to lower readmissions extended beyond targeted patients and conditions. Using the Nationwide Readmissions Database (2010-2015), we assessed trends in all-cause readmission rates for 1 of the 3 HRRP conditions (acute myocardial infarction, heart failure, pneumonia) or conditions not targeted by the HRRP in age-insurance groups defined by age group (≥65 years or <65 years) and payer (Medicare, Medicaid, or private insurance). In the group aged ≥65 years, readmission rates for those covered by Medicare, Medicaid, and private insurance decreased annually for acute myocardial infarction (risk-adjusted odds ratio [OR; 95% confidence interval] among Medicare patients, 0.94 [0.94-0.95], among Medicaid patients, 0.93 [0.90-0.97], and among patients with private-insurance, 0.95 [0.93-0.97]); heart failure (ORs, 0.96 [0.96-0.97], 0.96 [0.94-0.98], and 0.97 [0.96-0.99], for the 3 payers, respectively), and pneumonia (ORs, 0.96 [0.96-0.97), 0.94 [0.92-0.96], and 0.96 [0.95-0.97], respectively). Readmission rates also decreased in the group aged <65 years for acute myocardial infarction (ORs: Medicare 0.97 [0.96-0.98], Medicaid 0.94 [0.92-0.95], and private insurance 0.93 [0.92-0.94]), heart failure (ORs, 0.98 [0.97-0.98]: 0.96 [0.96-0.97], and 0.97 [0.95-0.98], for the 3 payers, respectively), and pneumonia (ORs, 0.98 [0.97-0.99], 0.98 [0.97-0.99], and 0.98 [0.97-1.00], respectively). Further, readmission rates decreased significantly for non-target conditions. There appears to be a systematic improvement in readmission rates for patient groups beyond the population of fee-for-service, older, Medicare beneficiaries included in the HRRP.
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DOI：
10.1001/jama.2017.17653
发表时间：
2017-11-28
期刊：
JAMA
影响因子：
--
作者：
Khera R;Angraal S;Couch T;Welsh JW;Nallamothu BK;Girotra S;Chan PS;Krumholz HM
通讯作者：
Krumholz HM
影响因子：
158.5
作者：
Zuckerman, Rachael B.;Sheingold, Steven H.;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.
影响因子：
39.2
作者：
Wasfy JH;Zigler CM;Choirat C;Wang Y;Dominici F;Yeh RW
通讯作者：
Yeh RW
DOI：
10.1161/circheartfailure.117.004402
发表时间：
2017-11
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Khera R;Pandey A;Ayers CR;Agusala V;Pruitt SL;Halm EA;Drazner MH;Das SR;de Lemos JA;Berry JD
通讯作者：
Berry JD
影响因子：
120.7
作者：
Desai, Nihar R.;Ross, Joseph S.;Horwitz, Leora I.
通讯作者：
Horwitz, Leora I.