Children's Hospital Characteristics and Readmission Metrics
Children's Hospital Characteristics and Readmission Metrics
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DOI：
10.1542/peds.2016-1720
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发表时间：
2017-02-01
期刊：
影响因子：
8
通讯作者：
Shah, Samir S.
中科院分区：
文献类型：
--
作者：
Auger, Katherine A.;Teufel, Ronald J., II;Shah, Samir S.
背景和目的：与成人医院一样，儿科医院也越来越多地面临因再次入院而受到经济处罚的风险。关于医院患者人群的构成如何影响这一指标的表现，从而影响提供儿科护理的医院的报销的信息有限。我们试图确定是否应用不同的再入院指标差异影响医院绩效的基础上的特点，医院serves.METHODS：我们进行了一项横断面分析，64儿童医院从儿童医院协会病例组合比较数据库2012年和2013年。我们通过使用全因（AC）和潜在可排除再入院（PPR）指标计算了30天排除再入院与预期再入院的比率。我们采用多元线性回归分析了预期达标率和医院特征之间的关系。结果：我们共调查了1416716例住院病例。平均AC 30天再入院率为11.3%（范围4.3%-19.6%）;平均PPR率为4.9%（范围2.9%-6.9%）。平均30天AC预期值与预期值之比为0.96（范围0.63-1.23），而PPR为0.95（范围0.65-1.23）; 59%的医院在两项指标上的表现均优于预期。医院与较高的容量，较低的百分比的婴儿，和低收入的患者的百分比较高的执行差于预期的PPR.CONCLUSIONS：高容量的医院，那些服务较少的婴儿，和那些高比例的患者从低收入的社区有高于预期的PPR率，并在较高的风险报销处罚。
BACKGROUND AND OBJECTIVE: Like their adult counterparts, pediatric hospitals are increasingly at risk for financial penalties based on readmissions. Limited information is available on how the composition of a hospital's patient population affects performance on this metric and hence affects reimbursement for hospitals providing pediatric care. We sought to determine whether applying different readmission metrics differentially affects hospital performance based on the characteristics of patients a hospital serves.METHODS: We performed a cross-sectional analysis of 64 children's hospitals from the Children's Hospital Association Case Mix Comparative Database 2012 and 2013. We calculated 30-day observed-to-expected readmission ratios by using both all-cause (AC) and Potentially Preventable Readmissions (PPR) metrics. We examined the association between observed-to-expected rates and hospital characteristics by using multivariable linear regression.RESULTS: We examined a total of 1 416 716 hospitalizations. The mean AC 30-day readmission rate was 11.3% (range 4.3%-19.6%); the mean PPR rate was 4.9% (range 2.9%-6.9%). The average 30-day AC observed-to-expected ratio was 0.96 (range 0.63-1.23), compared with 0.95 (range 0.65-1.23) for PPR; 59% of hospitals performed better than expected on both measures. Hospitals with higher volumes, lower percentages of infants, and higher percentage of patients with low income performed worse than expected on PPR.CONCLUSIONS: High-volume hospitals, those that serve fewer infants, and those with a high percentage of patients from low-income neighborhoods have higher than expected PPR rates and are at higher risk of reimbursement penalties.