Rehospitalizations among Patients in the Medicare Fee-for-Service Program
Rehospitalizations among Patients in the Medicare Fee-for-Service Program
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DOI：
10.1056/nejmsa0803563
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发表时间：
2009-04-02
影响因子：
158.5
通讯作者：
Coleman, Eric A.
中科院分区：
文献类型：
--
作者：
Jencks, Stephen F.;Williams, Mark V.;Coleman, Eric A.
降低再住院率作为提高护理质量和降低成本的一种方式已经引起了政策制定者的关注。然而，我们对美国再住院的频率和模式的信息有限，以帮助规划必要的变化。MethodsWe分析了2003-2004年的医疗保险索赔数据，以描述再住院的模式以及再住院与患者人口统计学特征和医院特征的关系。在出院的11，855，702名医疗保险受益人中，有19.6%在30天内再次住院，34.0%在90天内再次住院; 67.1%的已出院患者有医疗条件，51.5%的已出院患者有医疗条件。在接受外科手术后出院的患者中，有30%在出院后第一年内再次住院或死亡。在50.2%的患者在出院后30天内再次住院的情况下，在出院和再次住院之间没有到医生办公室就诊的账单。在手术出院后30天内再次住院的患者中，70.5%的患者因医疗状况再次住院。我们估计大约10%的再住院可能是有计划的。再次住院患者的平均住院时间比同一诊断相关组中最近一次住院至少6个月的患者长0.6天。我们估计，在2004年的计划外再住院医疗保险的成本为$17.4十亿。
BackgroundReducing rates of rehospitalization has attracted attention from policymakers as a way to improve quality of care and reduce costs. However, we have limited information on the frequency and patterns of rehospitalization in the United States to aid in planning the necessary changes.MethodsWe analyzed Medicare claims data from 2003-2004 to describe the patterns of rehospitalization and the relation of rehospitalization to demographic characteristics of the patients and to characteristics of the hospitals.ResultsAlmost one fifth (19.6%) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days, and 34.0% were rehospitalized within 90 days; 67.1% of patients who had been discharged with medical conditions and 51.5% of those who had been discharged after surgical procedures were rehospitalized or died within the first year after discharge. In the case of 50.2% of the patients who were rehospitalized within 30 days after a medical discharge to the community, there was no bill for a visit to a physician's office between the time of discharge and rehospitalization. Among patients who were rehospitalized within 30 days after a surgical discharge, 70.5% were rehospitalized for a medical condition. We estimate that about 10% of rehospitalizations were likely to have been planned. The average stay of rehospitalized patients was 0.6 day longer than that of patients in the same diagnosis-related group whose most recent hospitalization had been at least 6 months previously. We estimate that the cost to Medicare of unplanned rehospitalizations in 2004 was $17.4 billion.ConclusionsRehospitalizations among Medicare beneficiaries are prevalent and costly.