Healthy Days at home: A novel population-based outcome measure
Healthy Days at home: A novel population-based outcome measure
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DOI：
10.1016/j.hjdsi.2019.100378
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发表时间：
2020-03-01
影响因子：
2.5
通讯作者：
Jha, Ashish K.
中科院分区：
文献类型：
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作者：
Burke, Laura G.;Orav, E. John;Jha, Ashish K.
背景资料：Healthy Days at Home（HDAH）是一种新型的基于人群的结果测量方法，与Medicare Payment Advisory Commission.Methods合作开发：我们确定了受益人年龄，性别，种族和医疗补助资格，死亡日期，慢性疾病和医疗保健利用率，其中2016年20%的Medicare受益人样本。对于每个受益人，我们通过从365天中减去以下指标组成部分来计算当年的HDAH：死亡天数，住院总天数，观察，熟练护理设施（SNF），住院精神病，住院康复和长期医院设置以及门诊急诊和家庭健康访问的数量。我们研究了HDAH及其组成部分如何因受益人人口统计学特征和慢性病负担以及医疗保健市场（医院转诊区域）而变化。我们指定了一个患者水平的线性回归调整模型，以HDAH为结果，并将市场固定效应以及受益人年龄，性别和慢性疾病仓库类别作为协变量。我们研究了将家庭健康访视纳入该措施的影响，以及市场人口统计学和卫生系统特征与平均市场HDAH之间的关联。我们研究了HDAH从2013年到2016年的变化情况。结果：我们样本中65岁及以上的6，637，568名受益人的平均HDAH为347.2，80岁及以上的平均HDAH为325.3，而患有三种或三种以上慢性疾病的平均HDAH为333.7。导致HDAH减少最多的组成部分是死亡率（7.4天），家庭健康（2.7次访问），SNF使用（2.4天）和住院护理（1.5天）。表现最差的市场有5.8调整HDAH平均相比，全国平均值，而受益人在表现最好的市场有5.0以上的HDAH平均相比，全国平均值，在所有受益人年龄65岁及以上。结论：HDAH是一个以人口为基础的质量措施与大量的市场水平的变化。含义：HDAH认识到医疗保健的多维性，可以为提供者提供更大的灵活性，以根据患者的独特需求定制质量改进计划。
Background: Healthy Days at Home (HDAH) is a novel population-based outcome measure developed in conjunction with the Medicare Payment Advisory Commission.Methods: We identified beneficiary age, sex, race, and Medicaid eligibility, death date, chronic conditions and healthcare utilization among a 20% sample of Medicare beneficiaries in 2016. For each beneficiary we calculated HDAH for the year by subtracting the following measure components from 365 days: mortality days, the total number of days spent in inpatient, observation, skilled nursing facilities (SNF), inpatient psychiatry, inpatient rehabilitation and long-term hospital settings as well as the number of outpatient emergency department and home health visits. We examined how HDAH and its components varied by beneficiary demographic characteristics and chronic condition burden as well as by healthcare market (Hospital Referral Region). We specified a patient-level linear regression adjustment model with HDAH as the outcome and incorporated market fixed effects as well as beneficiary age, sex, and Chronic Conditions Warehouse categories as covariates. We examined the impact of including home health visits in the measure, as well as the association between market demographics and health system characteristics and mean market HDAH. We examined how HDAH changed from 2013 to 2016.Results: The 6,637,568 beneficiaries age 65 and older in our sample had a mean of 347.2 HDAH, those 80 and older had a mean of 325.3 while those with three or more chronic conditions had a mean of 333.7. The components that led to the largest reduction in HDAH were mortality (7.4 days), home health (2.7 visits), SNF utilization (2.4 days) and inpatient care (1.5 days). The worst performing market had 5.8 fewer adjusted HDAH on average compared to the national mean, while beneficiaries in the best-performing market had 5.0 more HDAH on average compared to the national mean, among all beneficiaries age 65 and older.Conclusions: HDAH is a population-based quality measure with substantial market-level variation. Implications: HDAH recognizes the multidimensional nature of healthcare and may afford providers greater flexibility to tailor quality-improvement initiatives to the unique needs of their patients.