Evaluation of Hospital Performance Using the Excess Days in Acute Care Measure in the Hospital Readmissions Reduction Program.
Evaluation of Hospital Performance Using the Excess Days in Acute Care Measure in the Hospital Readmissions Reduction Program.
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DOI：
10.7326/m20-3486
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发表时间：
2021-01
影响因子：
39.2
通讯作者：
Yeh RW
中科院分区：
文献类型：
--
作者：
Wadhera RK;Joynt Maddox KE;Desai NR;Landon BE;Md MV;Gilstrap LG;Shen C;Yeh RW
医院再入院减少计划（HRRP）迄今已对30天再入院率较高的医院进行了超过30亿美元的处罚。临床医生和政策专家担心，该计划中使用的30天再入院措施提供了一个不完整的表现，因为它没有捕捉到出院后可能发生的所有医院遭遇。相比之下，目前HRRP中未使用的急诊护理超额天数（EDAC）指标涵盖了出院后30天内的所有医院就诊（急诊科、观察住院、住院再入院）及其相关住院时间。这项研究对2019财年参与HRRP的3173家医院进行了比较，比较了再入院和EDAC措施的表现，并评估了使用EDAC措施是否会改变HRRP针对的3种情况的医院处罚状况。总体而言，通过使用再入院和EDAC指标，仅发现医院绩效排名中度一致（加权κ统计：心力衰竭，0.45 [95% CI，0.42 - 0.47];急性心肌梗死[AMI]，0.37 [CI，0.35 - 0.40];肺炎，0.50 [CI，0.47 - 0.52]）。根据HRRP，769（27.0%）的2845家医院的心力衰竭，581（28.3%）的2055个AMI和724（24.9%）的2911个肺炎的处罚状态将改变，如果EDAC措施，而不是再入院措施来评估性能。受到处罚的小型和农村医院将减少。医疗保险和医疗补助服务中心应考虑使用EDAC指标，该指标提供了出院后医院使用的更全面的情况，而不是30天再入院指标，以评估医疗保健系统在联邦质量、报告和基于价值的计划下的表现。
The Hospital Readmissions Reduction Program (HRRP) has penalized hospitals with higher 30-day readmission rates more than $3 billion to date. Clinicians and policy experts have raised concerns that the 30-day readmission measure used in this program provides an incomplete picture of performance because it does not capture all hospital encounters that may occur after discharge. In contrast, the excess days in acute care (EDAC) measure, which currently is not used in the HRRP, captures the full spectrum of hospital encounters (emergency department, observation stay, inpatient readmission) and their associated lengths of stay within 30 days of discharge. This study of 3173 hospitals that participated in the HRRP in fiscal year 2019 compared performance on the readmission and EDAC measures and evaluated whether using the EDAC measure would change hospitals’ penalty status for 3 conditions targeted by the HRRP. Overall, only moderate agreement was found on hospital performance rankings by using the readmission and EDAC measures (weighted κ statistic: heart failure, 0.45 [95% CI, 0.42 to 0.47]; acute myocardial infarction [AMI], 0.37 [CI, 0.35 to 0.40]; and pneumonia, 0.50 [CI, 0.47 to 0.52]). Under the HRRP, the penalty status of 769 (27.0%) of 2845 hospitals for heart failure, 581 (28.3%) of 2055 for AMI, and 724 (24.9%) of 2911 for pneumonia would change if the EDAC measure were used instead of the readmission measure to evaluate performance. Fewer small and rural hospitals would receive penalties. The Centers for Medicare & Medicaid Services should consider using the EDAC measure, which provides a more comprehensive picture of postdischarge hospital use, rather than the 30-day readmission measure to evaluate health care system performance under federal quality, reporting, and value-based programs.