Preventable readmissions within 30 days of ischemic stroke among Medicare beneficiaries.
Preventable readmissions within 30 days of ischemic stroke among Medicare beneficiaries.
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DOI：
10.1161/strokeaha.113.003165
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发表时间：
2013-12
期刊：
影响因子：
8.3
通讯作者：
Goldstein LB
中科院分区：
文献类型：
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作者：
Lichtman JH;Leifheit-Limson EC;Jones SB;Wang Y;Goldstein LB
医疗保险和医疗补助服务中心（CMS）建议从2016年开始，将缺血性卒中后30天的再入院作为医院住院患者质量报告计划的一部分，用于确定付款。中风后再入院的比例是潜在的预防是未知的。分析了2005年12月至2006年11月期间，所有年龄≥65岁、主要诊断为缺血性卒中（ICD-9-CM 433、434、436）且存活出院的Medicare按服务收费受益人的30天再入院情况。根据美国医疗保健研究和质量机构（AHRQ）开发的14项预防质量指标，确定了可接受的再入院。估计了国家、医院和地区可预防的再入院率。随机效应逻辑回归模型也被用来确定与可预防的再入院相关的患者水平因素。在307，887例缺血性卒中出院病例中，44，379例（14.4%）在30天内再次入院; 5，322例（占所有出院病例的1.7%）是可预防原因的结果（例如，肺炎）和39，057（12.7%）是由于其他原因（例如，癌症）。在多变量分析中，年龄较大和心血管相关共病是可预防再入院的强预测因素。可接受的再入院率在东南部、大西洋中部和美国领土最高，在山区和太平洋地区最低。根据AHRQ预防质量指标，我们发现一小部分缺血性卒中后再入院被归类为可预防的。虽然AHRQ措施中没有反映的其他再入院原因也是可以避免的，但旨在减少全因再入院和降低成本的医院级计划应该针对这些高风险患者。
The Centers for Medicare and Medicaid Services (CMS) proposes to use 30-day hospital readmissions after ischemic stroke as part of the Hospital Inpatient Quality Reporting Program for payment determination beginning in 2016. The proportion of post-stroke readmissions that is potentially preventable is unknown. Thirty-day readmissions for all Medicare fee-for-service beneficiaries aged ≥65 years discharged alive with a primary diagnosis of ischemic stroke (ICD-9-CM 433, 434, 436) between 12/2005-11/2006 were analyzed. Preventable readmissions were identified based on 14 Prevention Quality Indicators developed for use with administrative data by the US Agency for Healthcare Research and Quality (AHRQ). National, hospital-level, and regional preventable readmission rates were estimated. A random-effects logistic regression model was also used to determine patient-level factors associated with preventable readmissions. Among 307,887 ischemic stroke discharges, 44,379 (14.4%) were readmitted within 30 days; 5,322 (1.7% of all discharges) were the result of a preventable cause (e.g., pneumonia) and 39,057 (12.7%) were for other reasons (e.g., cancer). In multivariate analysis, older age and cardiovascular-related comorbid conditions were strong predictors of preventable readmissions. Preventable readmission rates were highest in the Southeast, Mid-Atlantic, and US territories and lowest in the Mountain and Pacific regions. Based on the AHRQ Prevention Quality Indicators, we found that a small proportion of readmissions after ischemic stroke were classified as preventable. Although other causes of readmissions not reflected in the AHRQ measures could also be avoidable, hospital-level programs intended to reduce all-cause readmissions and reduce costs should target these high-risk patients.