Readmissions, Observation, and the Hospital Readmissions Reduction Program
Readmissions, Observation, and the Hospital Readmissions Reduction Program
复制标题
DOI：
10.1056/nejmsa1513024
复制
发表时间：
2016-04-21
影响因子：
158.5
通讯作者：
Epstein, Arnold M.
中科院分区：
文献类型：
--
作者：
Zuckerman, Rachael B.;Sheingold, Steven H.;Epstein, Arnold M.
背景《平价医疗法案》(ACA) 中包含的医院再入院减少计划对目标病症再入院率高于预期的医院实施经济处罚。一些政策分析人士担心，通过将返回的患者留在观察室而不是正式将他们重新送入医院，可以减少再入院率。我们研究了目标和非目标条件下再入院率和观察室停留时间随时间的变化，并评估了观察服务使用量增加较多的医院是否能更大程度地减少再入院率。方法我们比较了 2007 年 10 月至 2015 年 5 月期间医疗保险老年受益人出院后 30 天内的每月医院级别再入院率和观察服务使用率。我们使用中断时间序列模型来确定趋势何时发生变化以及变化是否不同目标条件和非目标条件之间。我们评估了 2010 年 3 月采用 ACA 后再入院率变化与观察服务使用之间的相关性。结果我们分析了来自 3387 家医院的数据。从2007年到2015年，目标病症的再入院率从21.5%下降到17.8%，非目标病症的再入院率从15.3%下降到13.1%。 《平价医疗法案》通过后不久，再入院率迅速下降，特别是针对目标病症，然后在 2012 年 10 月之后继续以较慢的速度下降，无论是针对目标病症还是非目标病症。因目标病症而留在观察单位的比例从 2007 年的 2.6% 增加到 2015 年的 4.7%，因非目标病症而留在观察单位的比例从 2.5% 增加到 4.2%。在医院内部，实施 ACA 后观察室停留时间的变化与再入院之间没有显着关联。结论 再入院趋势与医院对减少再入院激励措施的反应一致，包括根据 ACA 对再入院的经济处罚。我们没有发现证据表明观察单元停留时间的变化导致了再入院率的下降。
BACKGROUNDThe Hospital Readmissions Reduction Program, which is included in the Affordable Care Act (ACA), applies financial penalties to hospitals that have higher-than-expected readmission rates for targeted conditions. Some policy analysts worry that reductions in readmissions are being achieved by keeping returning patients in observation units instead of formally readmitting them to the hospital. We examined the changes in readmission rates and stays in observation units over time for targeted and nontargeted conditions and assessed whether hospitals that had greater increases in observation-service use had greater reductions in readmissions.METHODSWe compared monthly, hospital-level rates of readmission and observation-service use within 30 days after hospital discharge among Medicare elderly beneficiaries from October 2007 through May 2015. We used an interrupted time-series model to determine when trends changed and whether changes differed between targeted and nontargeted conditions. We assessed the correlation between changes in readmission rates and use of observation services after adoption of the ACA in March 2010.RESULTSWe analyzed data from 3387 hospitals. From 2007 to 2015, readmission rates for targeted conditions declined from 21.5% to 17.8%, and rates for nontargeted conditions declined from 15.3% to 13.1%. Shortly after passage of the ACA, the readmission rate declined quickly, especially for targeted conditions, and then continued to fall at a slower rate after October 2012 for both targeted and nontargeted conditions. Stays in observation units for targeted conditions increased from 2.6% in 2007 to 4.7% in 2015, and rates for nontargeted conditions increased from 2.5% to 4.2%. Within hospitals, there was no significant association between changes in observation-unit stays and readmissions after implementation of the ACA.CONCLUSIONSReadmission trends are consistent with hospitals' responding to incentives to reduce readmissions, including the financial penalties for readmissions under the ACA. We did not find evidence that changes in observation-unit stays accounted for the decrease in readmissions.