Evaluation of an intervention targeted with predictive analytics to prevent readmissions in an integrated health system: observational study.
Evaluation of an intervention targeted with predictive analytics to prevent readmissions in an integrated health system: observational study.
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DOI：
10.1136/bmj.n1747
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发表时间：
2021-08-11
期刊：
影响因子：
--
通讯作者：
Schuler A
中科院分区：
文献类型：
--
作者：
Marafino BJ;Escobar GJ;Baiocchi MT;Liu VX;Plimier CC;Schuler A
确定大型综合医疗保健系统中针对出院后患者的护理协调干预（过渡计划）与30天再入院和死亡率之间的相关性。观察性研究。21家医院由北方加州的凯撒医疗机构运营。从2010年6月至2018年12月，1 539 285例符合条件的索引医院入院，对应于739 040例独特患者。411507例患者在实施过渡计划后出院;其中80424例（19.5%）患者处于中等或高预测风险，并在出院后被分配接受干预。根据电子健康记录数据，如果患者30天再入院或死亡的预测风险大于25%，则自动分配入院患者在出院后30天内接受过渡计划随访。出院后30天内的非择期再入院和全因死亡率。差异中的差异估计表明，干预与30天非择期再入院的几率显著降低相关（调整后的比值比0.91，95%置信区间0.89至0.93;绝对风险降低（95%置信区间-2.5%，-3.1%至2.0%），但与出院后30天死亡率的比值（1.00，0.95至1.04）无关。基于回归不连续性估计，在接近入组风险阈值的中等风险患者中，与再入院的相关性相似（绝对风险降低-2.7%，-3.2%至-2.2%）。然而，与出院后死亡率（-0.7%-1.4%至-0.0%）相关性的回归不连续性估计值具有显著性，表明该亚组患者获益。在综合卫生系统中，实施全面的再入院预防干预与30天再入院率的降低相关。此外，除了在中等风险患者中发现了一些有益的证据外，该研究与出院后30天的死亡率没有关联，总之，该研究提供了证据表明在社区环境中预防再入院干预措施的有效性，但可能需要进一步的研究来证实该研究结果。
To determine the associations between a care coordination intervention (the Transitions Program) targeted to patients after hospital discharge and 30 day readmission and mortality in a large, integrated healthcare system. Observational study. 21 hospitals operated by Kaiser Permanente Northern California. 1 539 285 eligible index hospital admissions corresponding to 739 040 unique patients from June 2010 to December 2018. 411 507 patients were discharged post-implementation of the Transitions Program; 80 424 (19.5%) of these patients were at medium or high predicted risk and were assigned to receive the intervention after discharge. Patients admitted to hospital were automatically assigned to be followed by the Transitions Program in the 30 days post-discharge if their predicted risk of 30 day readmission or mortality was greater than 25% on the basis of electronic health record data. Non-elective hospital readmissions and all cause mortality in the 30 days after hospital discharge. Difference-in-differences estimates indicated that the intervention was associated with significantly reduced odds of 30 day non-elective readmission (adjusted odds ratio 0.91, 95% confidence interval 0.89 to 0.93; absolute risk reduction 95% confidence interval −2.5%, −3.1% to −2.0%) but not with the odds of 30 day post-discharge mortality (1.00, 0.95 to 1.04). Based on the regression discontinuity estimate, the association with readmission was of similar magnitude (absolute risk reduction −2.7%, −3.2% to −2.2%) among patients at medium risk near the risk threshold used for enrollment. However, the regression discontinuity estimate of the association with post-discharge mortality (−0.7% −1.4% to −0.0%) was significant and suggested benefit in this subgroup of patients. In an integrated health system, the implementation of a comprehensive readmissions prevention intervention was associated with a reduction in 30 day readmission rates. Moreover, there was no association with 30 day post-discharge mortality, except among medium risk patients, where some evidence for benefit was found. Altogether, the study provides evidence to suggest the effectiveness of readmission prevention interventions in community settings, but further research might be required to confirm the findings beyond this setting.
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影响因子：
2.6
作者：
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通讯作者：
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158.5
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作者：
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