An administrative claims measure suitable for profiling hospital performance based on 30-day all-cause readmission rates among patients with acute myocardial infarction.
An administrative claims measure suitable for profiling hospital performance based on 30-day all-cause readmission rates among patients with acute myocardial infarction.
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DOI：
10.1161/circoutcomes.110.957498
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发表时间：
2011-03
期刊：
影响因子：
--
通讯作者：
Normand SL
中科院分区：
文献类型：
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作者：
Krumholz HM;Lin Z;Drye EE;Desai MM;Han LF;Rapp MT;Mattera JA;Normand SL
国家的注意力越来越集中于将重新接纳作为提高质量的目标。我们介绍了一个由国家质量论坛批准并由医疗保险和医疗补助服务中心使用的模型的开发和验证，该模型用于在医院级别公开报告急性心肌梗死后出院患者的风险标准化再住院率。我们开发了一个分层Logistic回归模型来计算急性心肌梗死住院患者的医院风险标准化30天全原因再住院率。该模型是使用2006年队列的联邦医疗保险索赔数据得出的，并使用索赔和医疗记录数据进行了验证。未调整的再住院率为18.9%。最终的模型包括31个变量，其分辨率从最低预测值的30天再住院率8%到最高预测值的32%，C统计量为0.63。3890家医院风险标化再住院率第25和第75百分位数分别为18.6%和19.1%，第5和第95百分位数分别为18.0%和19.9%。高于平均水平1 SD的医院全原因再入院的几率是低于平均水平1 SD的医院的1.35倍。使用索赔模型计算的医院级别调整后的再住院率与使用病历模型计算的相同队列的再住院率相似(相关系数为0.98；中位数差异为0.02个百分点)。这种以索赔为基础的急性心肌梗死患者医院风险标准化再住院率模型产生的估计值是那些从病历模型产生的估计值的极好替代。
National attention has increasingly focused on readmission as a target for quality improvement. We present the development and validation of a model approved by the National Quality Forum and used by the Centers for Medicare & Medicaid Services for hospital-level public reporting of risk-standardized readmission rates for patients discharged from the hospital after an acute myocardial infarction. We developed a hierarchical logistic regression model to calculate hospital risk-standardized 30-day all-cause readmission rates for patients hospitalized with acute myocardial infarction. The model was derived using Medicare claims data for a 2006 cohort and validated using claims and medical record data. The unadjusted readmission rate was 18.9%. The final model included 31 variables and had discrimination ranging from 8% observed 30-day readmission rate in the lowest predictive decile to 32% in the highest decile and a C statistic of 0.63. The 25th and 75th percentiles of the risk-standardized readmission rates across 3890 hospitals were 18.6% and 19.1%, with fifth and 95th percentiles of 18.0% and 19.9%, respectively. The odds of all-cause readmission for a hospital 1 SD above average were 1.35 times that of a hospital 1 SD below average. Hospital-level adjusted readmission rates developed using the claims model were similar to rates produced for the same cohort using a medical record model (correlation, 0.98; median difference, 0.02 percentage points). This claims-based model of hospital risk-standardized readmission rates for patients with acute myocardial infarction produces estimates that are excellent surrogates for those produced from a medical record model.