Quantifying the Impact of Care Fragmentation on Outcomes After Transcatheter Aortic Valve Implantation.
Quantifying the Impact of Care Fragmentation on Outcomes After Transcatheter Aortic Valve Implantation.
复制标题
量化护理分散化对经导管主动脉瓣植入后结果的影响。
DOI：
10.1016/j.amjcard.2020.05.005
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Kaneko,Tsuyoshi
中科院分区：
文献类型：
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作者：
Hirji,SameerA;Zogg,CherylK;Vaduganathan,Muthiah;Kiehm,Spencer;Percy,EdwardD;Yazdchi,Farhang;Pelletier,Marc;Shah,PinakB;Bhatt,DeepakL;O'Gara,Patrick;Kaneko,Tsuyoshi
医疗保险和医疗补助服务中心已将再入院确定为评估医院绩效和护理价值的重要质量指标。本研究的目的是量化“护理碎片化”对经导管主动脉瓣植入术（TAVI）结局的影响。再次入住非索引医院定义为除施行TAVI的医院以外的任何医院。在这项多中心、基于人群、具有全国代表性的研究中，分析了国家再入院数据库中2010年1月1日至2015年9月31日期间接受TAVI的美国成年患者的全国加权队列。对90天非首次再入院后的患者特征、趋势和结局进行了评价。使用30天度量作为比较的参考组。加权后共有51，092例患者符合入选标准。总体而言，TAVI术后90天再入院率为27.6%（30天参考组：17.4%），其中42%的再入院是在非索引医院。非心脏原因占大多数非索引再入院，但主要的心脏手术更有可能在索引医院在90天内再入院。尽管再次入住非指标医院的患者的合并症负担较高，但与90天的指标再入院相比，非指标再入院后的未校正和风险校正全因死亡率、再入院住院时间和总住院费用均较低。总之，在这个真实的世界中，美国TAVI患者的全国代表性队列中，护理碎片化仍然普遍存在，并代表了未来卫生政策的持久残留目标。虽然有影响力的再入院可能是针对索引医院，但需要共同努力解决增加护理碎片化的机制。
The Center for Medicare & Medicaid Services has identified readmission as an important quality metric in assessing hospital performance and value of care. The aim of this study was to quantify the impact of “care fragmentation” on transcatheter aortic valve implantation (TAVI) outcomes. Readmission to nonindex hospitals was defined as any hospital other than the hospital where the TAVI was performed. In this multicenter, population-based, nationally representative study, a nationally weighted cohort of US adult patients who underwent TAVI in the National Readmission Database between 01/01/2010 and 9/31/2015 were analyzed. Patient characteristics, trends, and outcomes after 90-day nonindex readmission were evaluated. Thirty-day metric was used as a reference group for comparison. A weighted total of 51,092 patients met inclusion criteria. Overall, the 90-day readmission rate after TAVI was 27.6% (30-day reference group: 17.4%), and 42% of these readmissions were to nonindex hospitals. Noncardiac causes accounted for most nonindex readmissions, but major cardiac procedures were more likely performed at index hospitals during readmission within 90 days. Despite the high co-morbidity burden of patients readmitted to nonindex hospitals, unadjusted and risk-adjusted all-cause mortality, readmission length of stay and total hospital costs following nonindex readmission were lower compared with index readmission at 90 days. In conclusion, in this real world, nationally representative cohort of TAVI patients in the United States, care fragmentation remains prevalent and represent an enduring, residual target for future health policies. Although the impactful readmissions may be directed toward index hospitals, concerted efforts are needed to address mechanisms that increase care fragmentation.