Decreases In Readmissions Credited To Medicare's Program To Reduce Hospital Readmissions Have Been Overstated
Decreases In Readmissions Credited To Medicare's Program To Reduce Hospital Readmissions Have Been Overstated
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DOI：
10.1377/hlthaff.2018.05178
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发表时间：
2019-01-01
期刊：
影响因子：
9.7
通讯作者：
Cutler, David M.
中科院分区：
文献类型：
--
作者：
Ody, Christopher;Msall, Lucy;Cutler, David M.
医疗保险的医院再入院减少计划（HRRP）已被认为是降低风险调整再入院率的目标条件在普通急症护理医院。然而，这些减少似乎是虚幻的或夸大的。这是因为电子交易标准的同步变化允许医院记录每笔索赔的更多诊断，从而降低了经风险调整后的患者再入院率。先前的HRRP研究依赖于对照组的基线再入院率较低，这可能会错误地造成再入院率在治疗中比对照组变化更大的假象。考虑到修订后的标准，针对目标条件的风险调整再入院率下降了48%。在进一步调整了样本中hrrp前再入院率的差异后，我们发现普通急症医院目标疾病的下降在统计上与两个对照样本的下降没有区别。HRRP要么对再入院没有影响，要么导致整个系统的再入院减少，大约是先前估计的一半。
Medicare's Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a concurrent change in electronic transaction standards allowed hospitals to document a larger number of diagnoses per claim, which had the effect of reducing risk-adjusted patient readmission rates. Prior studies of the HRRP relied upon control groups' having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group. Accounting for the revised standards reduced the decline in risk-adjusted readmission rates for targeted conditions by 48 percent. After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples. Either the HRRP had no effect on readmissions, or it led to a systemwide reduction in readmissions that was roughly half as large as prior estimates have suggested.