Influence of Nonindex Hospital Readmission on Length of Stay and Mortality
Influence of Nonindex Hospital Readmission on Length of Stay and Mortality
复制标题
DOI：
10.1097/mlr.0000000000000829
复制
发表时间：
2018-01-01
期刊：
影响因子：
3
通讯作者：
Ginde, Adit A.
中科院分区：
文献类型：
--
作者：
Burke, Robert E.;Jones, Christine D.;Ginde, Adit A.
重要性：医院和卫生保健系统面临着对患者出院后结果越来越多的责任，但目前尚不清楚，特别是在不同医院再次住院的频率与指数住院的频率有多高，以及这是否与更差的结果有关。目的：描述所有支付者的全国代表性样本中非指数30天再入院的患病率及其与结果的关联。设计：对2013年全国再入院数据库进行二次回顾性分析。环境：来自21个州的非联邦医院，占美国每年住院人数的一半。参与者：我们的总体样本包括所有住院30天随访后活着出院的成年人；我们还创建了3个额外的队列：以医疗保险作为付款人的患者（医疗保险队列），出院后到家庭健康或熟练护理机构的患者（急性后护理队列），以及具有当前医院减少再入院计划惩罚条件的医疗保险患者（再入院惩罚队列）。暴露：30天内再入院到“指标”医院（在“指标”住院）或“非指标”医院。主要转归和测量指标：住院死亡率和再入院期间的住院时间。结果：加权总体样本包括2004个独特医院的22,884,505例出院患者。总体30天再入院率为11.9%，其中22.5%发生在非指标医院。在整个样本和3个队列中，非指标机构的再入院与院内死亡率的增加（优势比为1.21；95%可信区间为1.17-1.25）和住院时间的延长（出院风险比为0.87；95%可信区间为0.86-0.88）相关。结论和相关性：非指标再入院很常见，且预后较差；跨队列的共同发现强调了医院和护理系统参与基于价值的支付模式的重要性。医院和护理系统应投资改进实时识别和干预这些患者的方法。
Importance: Hospitals and health care systems face increasing accountability for postdischarge outcomes of patients, but it is unclear how frequently hospital readmissions in particular occur at a different hospital than the index hospitalization and whether this is associated with worse outcomes.Objective: Describe the prevalence of nonindex 30-day readmissions in a nationally representative sample of all payers and associations with outcomes.Design: Secondary retrospective analysis of the 2013 Nationwide Readmissions Database.Setting: Nonfederal hospitals from 21 states representing half of hospitalizations in the United States annually.Participants: Our overall sample included all adults discharged alive from an inpatient stay with 30 days of follow-up; we also created 3 additional cohorts: patients with Medicare as the payer (Medicare cohort), patients discharged to home health or skilled nursing facilities after discharge (postacute care cohort), and Medicare patients with any of the current Hospital Readmission Reduction Program's penalized conditions (readmission penalty cohort).Exposure: Readmission within 30 days to "index" hospital (where index stay occurred) or "nonindex" hospital.Main Outcome(s) and Measure(s): In-hospital mortality and length of stay during the readmission.Results: The weighted overall sample included 22,884,505 hospital discharges from 2004 unique hospitals. The overall 30-day readmission rate was 11.9%, of these, 22.5% occurred at a nonindex hospital. Readmissions to nonindex facilities were associated with increased odds of in-hospital mortality (odds ratio, 1.21; 95% confidence interval, 1.17-1.25) and longer hospital length of stay (hazard ratio for hospital discharge, 0.87; 95% confidence interval, 0.86-0.88) in the overall sample and in the 3 cohorts.Conclusions and Relevance: Nonindex readmissions are common and associated with worse outcomes; the common findings across cohorts highlight the importance for hospitals and care systems participating in value-based payment models. Hospitals and care systems should invest in improved methods for real-time identification and intervention for these patients.