Impact of Risk Adjustment for Socioeconomic Status on Risk-adjusted Surgical Readmission Rates.
Impact of Risk Adjustment for Socioeconomic Status on Risk-adjusted Surgical Readmission Rates.
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DOI：
10.1097/sla.0000000000001363
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发表时间：
2016-04
影响因子：
9
通讯作者：
Dick AW
中科院分区：
文献类型：
--
作者：
Glance LG;Kellermann AL;Osler TM;Li Y;Li W;Dick AW
评估安全网医院（SNH）和非安全网医院之间再入院率的差异是否是由于医院质量的差异，并比较有和没有SES调整的医院分析结果。为了回应人们对质量措施不公平地惩罚安全网医院（SNH）的担忧，NQF最近建议，当社会经济地位（SES）是患者预后不良的风险因素时，应调整绩效措施。采用多元回归分析研究SNH状态与大手术后30天再入院之间的关系。使用CMS医院比较和医院再入院减少计划（HRRP）方法比较了有和没有SES调整的医院分析结果。调整患者风险和SES后，与非SNH患者相比，SNH患者再次入院的可能性并不高（AOR 1.08;95% CI：0.95-1.23;P = 0.23）。基于医院比较的医院分析结果在SES调整和未调整的情况下几乎相同（ICC 0.99，kappa 0.96）。使用HRRP阈值方法，61%的SNH被分配到惩罚组，而50%的非SNH被分配到惩罚组。在调整SES后，51%的SNH被分配到惩罚组。SNH和非SNH之间手术再入院的差异是由于低SES患者的患者病例组合的差异，而不是质量的差异。调整SES的再入院指标会导致使用HRRP阈值方法的医院排名发生变化，但不会使用CMS医院比较方法。CMS在计算HRRP的再入院阈值时应考虑调整SES的影响，或将其替换为医院比较中使用的方法。
To assess whether differences in readmission rates between safety-net hospitals (SNH) and non-SNHs are due to differences in hospital quality, and to compare the results of hospital profiling with and without SES adjustment. In response to concerns that quality measures unfairly penalizes safety-net hospitals (SNH), NQF recently recommended that performance measures adjust for socioeconomic status (SES) when SES is a risk factor for poor patient outcomes. Multivariate regression was used to examine the association between SNH status and 30-day readmission after major surgery. The results of hospital profiling with and without SES adjustment were compared using the CMS Hospital Compare and the Hospital Readmissions Reduction Program (HRRP) methodologies. Adjusting for patient risk and SES, patients admitted to SNHs were not more likely to be readmitted compared to patients in in non-SNHs (AOR 1.08;95% CI:0.95-1.23;P = 0.23). The results of hospital profiling based on Hospital Compare were nearly identical with and without SES adjustment (ICC 0.99, kappa 0.96). Using the HRRP threshold approach, 61% of SNHs were assigned to the penalty group versus 50% of non-SNHs. After adjusting for SES, 51% of SNHs were assigned to the penalty group. Differences in surgery readmissions between SNHs and non-SNHs are due to differences in the patient case mix of low-SES patients, and not to differences in quality. Adjusting readmission measures for SES leads to changes in hospital ranking using the HRRP threshold approach, but not using the CMS Hospital Compare methodology. CMS should consider either adjusting for the effects of SES when calculating readmission thresholds for HRRP, or replace it with the approach used in Hospital Compare.