Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre-Post Analysis.
Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre-Post Analysis.
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DOI：
10.7326/m16-0185
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发表时间：
2017-03-07
影响因子：
39.2
通讯作者：
Yeh RW
中科院分区：
文献类型：
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作者：
Wasfy JH;Zigler CM;Choirat C;Wang Y;Dominici F;Yeh RW
在医疗保险医院再入院减少计划 (HRRP) 通过后，风险标准化再入院率 (RSRR) 最高的医院是否随后经历了最大的改善尚不清楚。旨在评估 HRRP 通过后，因急性心肌梗死 (AMI)、充血性心力衰竭 (CHF) 或肺炎住院后 30 天 RSRR 是否会加速改善，以及在该法案通过后，表现最差的医院是否比表现良好的医院有更快的改善加速。按医院绩效组进行分层的前后分析。美国急症护理医院。 2000 年至 2013 年期间，有 15 170 008 名医疗保险患者活着出院。HRRP 的通过。表现最高（0% 罚分）、平均表现（>0% 且 <0.50% 罚分）、低表现（≥0.50% 且 <0.99% 罚分）和表现最低（≥0.99% 罚分）组的医院因 AMI、CHF 或肺炎住院后 30 天的再入院率。在每年为 1 109 530 名医疗保险出院者提供服务的 2868 家医院中，30.1% 为最高绩效医院，44.0% 为平均绩效医院，16.8% 为低绩效医院，9.0% 为最低绩效医院。在控制法前趋势后，发现每 10 000 例出院病例中，另外 67.6（95% CI，66.6 至 68.4）、74.8（CI，74.0 至 75.4）、85.4（CI，84.0 至 86.8）和 95.1（CI，92.6 至 97.5）的再入院得到避免该法律通过后，每年分别对最高、平均、低和最低绩效群体进行排名。无法区分惩罚幅度或不同患者群体健康改善程度不同所引起的改善。 HRRP 通过后，心肌梗死、心力衰竭和肺炎的 30 天 RSRR 比该法律通过前下降得更快。对于法学预科表现最差的医院来说，改善最为明显。
Whether hospitals with the highest risk-standardized readmission rates (RSRRs) subsequently experienced the greatest improvement after passage of the Medicare Hospital Readmissions Reduction Program (HRRP) is unknown. To evaluate whether passage of the HRRP was followed by acceleration in improvement in 30-day RSRRs after hospitalizations for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia and whether the lowest-performing hospitals had faster acceleration in improvement after passage of the law than hospitals that were already performing well. Pre–post analysis stratified by hospital performance groups. U.S. acute care hospitals. 15 170 008 Medicare patients discharged alive from 2000 to 2013. Passage of the HRRP. 30-day readmission rates after hospitalization for AMI, CHF, or pneumonia for hospitals in the highest-performance (0% penalty), average-performance (>0% and <0.50% penalty), low-performance (≥0.50% and <0.99% penalty), and lowest-performance (≥0.99% penalty) groups. Of 2868 hospitals serving 1 109 530 Medicare discharges annually, 30.1% were highest performers, 44.0% were average performers, 16.8% were low performers, and 9.0% were lowest performers. After controlling for prelaw trends, an additional 67.6 (95% CI, 66.6 to 68.4), 74.8 (CI, 74.0 to 75.4), 85.4 (CI, 84.0 to 86.8), and 95.1 (CI, 92.6 to 97.5) readmissions per 10 000 discharges were found to have been averted per year in the highest-, average-, low-, and lowest-performance groups, respectively, after passage of the law. Inability to distinguish between improvement caused by the magnitude of the penalty or by different levels of health improvement in different patient populations. After passage of the HRRP, 30-day RSRRs for myocardial infarction, heart failure, and pneumonia decreased more rapidly than before the law’s passage. Improvement was most marked for hospitals with the lowest prelaw performance.