Association Between Skilled Nursing Facility Quality Indicators and Hospital Readmissions
Association Between Skilled Nursing Facility Quality Indicators and Hospital Readmissions
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DOI：
10.1001/jama.2014.13513
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发表时间：
2014-10-15
影响因子：
120.7
通讯作者：
Werner, Rachel M.
中科院分区：
文献类型：
--
作者：
Neuman, Mark D.;Wirtalla, Christopher;Werner, Rachel M.
重要性医院再入院是常见的，昂贵的，而且可能是可以预防的。关于可获得的熟练护理设施（SNF）绩效指标与再入院风险之间的关联知之甚少。目的测量在美国接受SNF急性期后护理的医疗保险受益人中SNF绩效指标与再入院风险之间的关联。2009年9月1日至2010年8月31日期间，在急性护理住院后出院至SNF的医疗保险受益人，我们研究了SNF性能与公开可用指标之间的关联（SNF人员配备强度，通过现场检查确定的健康缺陷，以及SNF患者谵妄，中度至重度疼痛，以及新发或恶化的压疮）和出院至SNF后30天再入院或死亡的风险。调整后的分析控制了患者病例组合、SNF设施因素和出院医院。主要结局和指标：再次入住急症护理医院或出院后30天内死亡。（23.3%; 99%CI，23.3%-23.5%）在30天内再次入院或死亡; 72472例在30天内死亡（4.7%; 99% CI，4.7%-4.8%），321 709例再次入院（21.0%; 99% CI，20.9%-21.1%）。在具有更好的人员评级和更好的设施检查评级的SNF中，未调整的再入院或死亡风险较低。调整患者因素、SNF设施因素和出院医院减弱了这些相关性;我们观察到根据SNF设施检查评级调整后的再入院或死亡风险存在微小差异。其他措施没有预测调整后的再入院或death.CONCLUSIONS和相关性的风险有临床意义的差异收费服务医疗保险受益人出院后的SNF急性护理住院，可用的性能指标并不一致与调整后的再入院或死亡的风险差异。版权所有2014美国医学会。All rights reserved.
IMPORTANCE Hospital readmissions are common, costly, and potentially preventable. Little is known about the association between available skilled nursing facility (SNF) performance measures and the risk of hospital readmission.OBJECTIVE To measure the association between SNF performance measures and hospital readmissions among Medicare beneficiaries receiving postacute care at SNFs in the United States.DESIGN AND PARTICIPANTS Using national Medicare data on fee-for-service Medicare beneficiaries discharged to a SNF after an acute care hospitalization between September 1, 2009, and August 31, 2010, we examined the association between SNF performance on publicly available metrics (SNF staffing intensity, health deficiencies identified through site inspections, and the percentages of SNF patients with delirium, moderate to severe pain, and new or worsening pressure ulcers) and the risk of readmission or death 30 days after discharge to a SNF. Adjusted analyses controlled for patient case mix, SNF facility factors, and the discharging hospital.MAIN OUTCOMES AND MEASURES Readmission to an acute care hospital or death within 30 days of the index hospital discharge.RESULTS Of 1 530 824 patients discharged, 357 752 (23.3%; 99% CI, 23.3%-23.5%) were readmitted or died within 30 days; 72 472 died within 30 days (4.7%; 99% CI, 4.7%-4.8%), and 321 709 were readmitted (21.0%; 99% CI, 20.9%-21.1%). The unadjusted risk of readmission or death was lower at SNFs with better staffing ratings and better facility inspection ratings.[GRAPHICS]Adjustment for patient factors, SNF facility factors, and the discharging hospital attenuated these associations; we observed small differences in the adjusted risk of readmission or death according to SNF facility inspection ratings. Other measures did not predict clinically meaningful differences in the adjusted risk of readmission or death.CONCLUSIONS AND RELEVANCE Among fee-for-service Medicare beneficiaries discharged to a SNF after an acute care hospitalization, available performance measures were not consistently associated with differences in the adjusted risk of readmission or death. Copyright 2014 American Medical Association. All rights reserved.