Implications of Metric Choice for Common Applications of Readmission Metrics
Implications of Metric Choice for Common Applications of Readmission Metrics
复制标题
重新接纳指标的常见应用中指标选择的影响
DOI：
10.1111/1475-6773.12075
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发表时间：
2013-12-01
影响因子：
3.4
通讯作者：
Baker, Laurence C.
中科院分区：
文献类型：
--
作者：
Davies, Sheryl;Saynina, Olga;Baker, Laurence C.
目的量化三种再入院指标对医院绩效的不同影响：全因再入院（ACR）、3 M潜在可恢复再入院（PPR）和医疗保险和医疗补助中心30天再入院（CMS）。数据来源2000 -2009加州全州健康规划和发展办公室患者出院数据非公开文件。研究设计我们使用三个指标计算30天再入院率，三种疾病组：心力衰竭（HF）、急性心肌梗死（AMI）和肺炎。使用每个指标，我们计算了绝对变化和性能之间的相关性;医院的百分比保持在极端的十分位数和水平的协议;和纵向performance.Principal FindingsAverage医院率HF患者和CMS指标一般高于其他条件和指标。ACR和CMS指标之间的相关性最高（r=0.67-0.84）。使用PPR和ACR或CMS指标计算的比率中度相关（r=0.50-0.67）。根据一个指标，47%到75%的医院在使用不同的指标时仍然处于极端的十分位。指标之间的相关性是温和的，当衡量医院的纵向changes.ConclusionsDifferent方法来计算再入院可以产生不同的医院排名和影响按业绩付费。应仔细考虑这些应用程序的再入院指标选择。
ObjectiveTo quantify the differential impact on hospital performance of three readmission metrics: all-cause readmission (ACR), 3M Potential Preventable Readmission (PPR), and Centers for Medicare and Medicaid 30-day readmission (CMS).Data Sources2000-2009 California Office of Statewide Health Planning and Development Patient Discharge Data Nonpublic file.Study DesignWe calculated 30-day readmission rates using three metrics, for three disease groups: heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Using each metric, we calculated the absolute change and correlation between performance; the percent of hospitals remaining in extreme deciles and level of agreement; and differences in longitudinal performance.Principal FindingsAverage hospital rates for HF patients and the CMS metric were generally higher than for other conditions and metrics. Correlations between the ACR and CMS metrics were highest (r=0.67-0.84). Rates calculated using the PPR and either ACR or CMS metrics were moderately correlated (r=0.50-0.67). Between 47 and 75 percent of hospitals in an extreme decile according to one metric remained when using a different metric. Correlations among metrics were modest when measuring hospital longitudinal change.ConclusionsDifferent approaches to computing readmissions can produce different hospital rankings and impact pay-for-performance. Careful consideration should be placed on readmission metric choice for these applications.