Accounting for the Growth of Observation Stays in the Assessment of Medicare's Hospital Readmissions Reduction Program.
Accounting for the Growth of Observation Stays in the Assessment of Medicare's Hospital Readmissions Reduction Program.
复制标题
DOI：
10.1001/jamanetworkopen.2022.42587
复制
发表时间：
2022-11-01
影响因子：
13.8
通讯作者：
Wright, Brad
中科院分区：
文献类型：
--
作者：
Sabbatini, Amber K.;Joynt-Maddox, Karen E.;Liao, Joshua M.;Basu, Anirban;Parrish, Canada;Kreuter, William;Wright, Brad
在何种程度上增加的观察停留占减少再入院与医疗保险医院再入院减少计划（HRRP）？在这项队列研究中，包括8 944 295例住院病例，充分考虑了观察期，因为指标医院出院和再入院使30天再入院的明显减少减少了一半以上（-1.48 vs-0.66个百分点）。此外，协会的程序与较低的再入院率确定时，只有住院病人住院被认为是没有found.The研究结果表明，估计减少再入院与实施的HRRP可以归因于重新分类的住院病人入院观察停留。这项队列研究探讨了在考虑观察停留后，减少再入院计划与30天再入院之间的关系。在医疗保险医院再入院减少计划（HRRP）实施后，在医院观察住院使用增加的背景下，30天再入院人数有所减少，但再入院措施中并未记录观察住院时间。研究HRRP是否与考虑观察停留后30天再入院率的降低相关。这项回顾性队列研究包括2009年1月1日至2015年12月31日期间医疗保险按服务收费受益人中20%的住院和观察样本。数据分析于二零二一年十一月至二零二二年六月进行。差异中差异分析评估了在排除和包括观察停留的情况下，宣布HRRP和实施目标疾病（心力衰竭、急性心肌梗死和肺炎）与非目标疾病的惩罚后30天再入院率的变化。30天住院和观察期。本研究包括8 944 295例住院患者（平均[SD]年龄：78.7 [8.2]岁; 58.6%为女性; 1.3%为亚裔; 10.0%为黑人; 2.0%为西班牙裔; 0.5%为北美原住民; 85.0%为白色; 1.2%为其他或未知）。目标疾病的指标住院观察时间从2.3%增加至4.4%（相对增加91.3%），非目标疾病的指标住院观察时间从14.1%增加至21.3%（相对增加51.1%）。在HRRP公布后，再入院率显著下降，并在对目标和非目标条件实施惩罚时恢复到基线水平，无论是否包括观察停留。当仅计算住院患者时，再入院率下降了-1.48个百分点（95%CI，-1.65至-1.31个百分点）到目标条件处罚后阶段，再入院率绝对下降-1.13个百分点（95%CI，-1.30至-0.96个百分点）非目标条件的惩罚后期间再入院率的绝对下降。这一减少对应于-0.35个百分点的统计学显著差异变化（95% CI，-0.59至-0.11个百分点）。考虑到观察停留，目标条件的再入院率绝对下降了一半以上（-0.66个百分点; 95%CI，-0.83至-0.49个百分点）。同期非目标疾病的总体下降幅度更大（-0.76个百分点; 95% CI，-0.92至0.59个百分点），对应于再入院率的差异变化为0.10个百分点（95% CI，-0.14至0.33个百分点），这在统计学上并不显著。这项研究的结果表明，与实施HRRP相关的再入院率的减少比最初报告的要小。因目标疾病而再次入院的人数减少一半以上似乎是由于将住院病人重新分类为观察住院。
To what extent does the increase of observation stays account for the decrease in readmissions associated with the Medicare Hospital Readmissions Reduction Program (HRRP)? In this cohort study including 8 944 295 hospitalizations, fully accounting for observation stays as both index hospital discharges and readmissions more than halved the apparent decrease in 30-day readmissions (−1.48 vs −0.66 percentage points). In addition, an association of the program with lower readmission rates identified when only inpatient hospitalizations were considered was not found. The findings of this study suggest that much of the estimated reduction in readmissions associated with the implementation of the HRRP can be attributed to reclassification of inpatient admissions to observation stays. This cohort study examines the association between the Hospital Readmissions Reduction Program and 30-day readmissions after accounting for observation stays. Decreases in 30-day readmissions following the implementation of the Medicare Hospital Readmissions Reduction Program (HRRP) have occurred against the backdrop of increasing hospital observation stay use, yet observation stays are not captured in readmission measures. To examine whether the HRRP was associated with decreases in 30-day readmissions after accounting for observation stays. This retrospective cohort study included a 20% sample of inpatient admissions and observation stays among Medicare fee-for-service beneficiaries from January 1, 2009, to December 31, 2015. Data analysis was performed from November 2021 to June 2022. A differences-in-differences analysis assessed changes in 30-day readmissions after the announcement of the HRRP and implementation of penalties for target conditions (heart failure, acute myocardial infarction, and pneumonia) vs nontarget conditions under scenarios that excluded and included observation stays. Thirty-day inpatient admissions and observation stays. The study included 8 944 295 hospitalizations (mean [SD] age, 78.7 [8.2] years; 58.6% were female; 1.3% Asian; 10.0% Black; 2.0% Hispanic; 0.5% North American Native; 85.0% White; and 1.2% other or unknown). Observation stays increased from 2.3% to 4.4% (91.3% relative increase) of index hospitalizations among target conditions and 14.1% to 21.3% (51.1% relative increase) of index hospitalizations for nontarget conditions. Readmission rates decreased significantly after the announcement of the HRRP and returned to baseline by the time penalties were implemented for both target and nontarget conditions regardless of whether observation stays were included. When only inpatient hospitalizations were counted, decreasing readmissions accrued into a −1.48 percentage point (95% CI, −1.65 to −1.31 percentage points) absolute reduction in readmission rates by the postpenalty period for target conditions and −1.13 percentage point (95% CI, −1.30 to −0.96 percentage points) absolute reduction in readmission rates by the postpenalty period for nontarget conditions. This reduction corresponded to a statistically significant differential change of −0.35 percentage points (95% CI, −0.59 to −0.11 percentage points). Accounting for observation stays more than halved the absolute decrease in readmission rates for target conditions (−0.66 percentage points; 95% CI, −0.83 to –0.49 percentage points). Nontarget conditions showed an overall greater decrease during the same period (−0.76 percentage points; 95% CI, −0.92 to −0.59 percentage points), corresponding to a differential change in readmission rates of 0.10 percentage points (95% CI, −0.14 to 0.33 percentage points) that was not statistically significant. The findings of this study suggest that the reduction of readmissions associated with the implementation of the HRRP was smaller than originally reported. More than half of the decrease in readmissions for target conditions appears to be attributable to the reclassification of inpatient admission to observation stays.
登录
查看更多内容
影响因子：
39.2
作者：
Kind AJ;Jencks S;Brock J;Yu M;Bartels C;Ehlenbach W;Greenberg C;Smith M
通讯作者：
Smith M
影响因子：
9.7
作者：
Ferro, Enrico G.;Secemsky, Eric A.;Yeh, Robert W.
通讯作者：
Yeh, Robert W.
影响因子：
2.8
作者：
Gai, Yunwei;Pachamanova, Dessislava
通讯作者：
Pachamanova, Dessislava
影响因子：
2.8
作者：
Banerjee S;Paasche-Orlow MK;McCormick D;Lin MY;Hanchate AD
通讯作者：
Hanchate AD
影响因子：
9.7
作者：
Baker, Matthew C.;Alberti, Philip M.;Haberman, Merle
通讯作者：
Haberman, Merle