Variation in surgical-readmission rates and quality of hospital care.
Variation in surgical-readmission rates and quality of hospital care.
复制标题
DOI：
10.1056/nejmsa1303118
复制
发表时间：
2013-09-19
期刊：
影响因子：
--
通讯作者：
Jha AK
中科院分区：
文献类型：
--
作者：
Tsai TC;Joynt KE;Orav EJ;Gawande AA;Jha AK
减少再入院是临床和政策的优先事项，但对大手术后再入院率的变化以及医院的手术再入院率是否与高质量手术护理的其他指标相关知之甚少。使用国家医疗保险数据，我们计算了冠状动脉旁路移植术（CABG）、肺叶切除术、腹主动脉瘤腔内修复术（EVAR）、开放性腹主动脉瘤修复术（AAA）、结肠切除术和髋关节置换术住院后30天的再入院率。我们使用双变量和多变量技术来评估再入院率与其他手术质量指标之间的关系，包括手术过程指标、手术量和死亡率。在3，004家医院的六种索引程序之一之后，有479，471人出院。经风险调整的六次手术30天复合再入院率中位数为13.1% [四分位数间距，IQR 9.9%-17.1%}。调整医院特征后，我们发现手术量最高的四分位数医院的再入院率低于手术量最低的医院（12.7% vs. 16.8%，p<0.001），死亡率最低的医院的再入院率明显低于死亡率高的医院（13.3% vs. 14.2%，p<0.001）。手术过程护理性能指标的高性能仅与再入院率轻微相关（13.1% vs 13.6%，p=0.021）。当六个大手术中的每一个都被单独检查时，模式是相似的。近七分之一的患者在大手术后出院后30天内再次入院。高容量和低死亡率的医院比其他医院的手术再入院率低。
Reducing readmissions is a clinical and policy priority, but little is known about variations in readmission rates after major surgery and whether a hospital's surgical readmission rates are related to other markers of high-quality surgical care. Using national Medicare data, we calculated 30-day readmission rates after hospitalization for coronary artery bypass graft (CABG), pulmonary lobectomy, endovascular abdominal aortic aneurysm repair (EVAR), open abdominal aortic aneurysm repair (AAA), colectomy, and hip replacement. We used bivariate and multivariable techniques to assess the relationship between readmission rates and other measures of surgical quality, including performance on surgical process measures, procedure volume, and mortality. There were 479,471 discharges following one of the six index procedures from 3,004 hospitals. The median risk-adjusted six-procedure composite 30-day readmission rate was 13.1% [interquartile range, IQR 9.9%-17.1%}. Adjusting for hospital characteristics, we found that hospitals in the highest quartile of surgical volume had lower readmission rates than the lowest-volume hospitals (12.7% vs. 16.8%, p<0.001), and hospitals with the lowest mortality rates had significantly lower readmission rates than hospitals with high mortality rates (13.3% vs. 14.2%, p<0.001). High performance on surgical process of care performance measures was only marginally associated with readmission rates (13.1% versus 13.6%, p=0.021). Patterns were similar when each of the six major surgeries was examined individually. Nearly one in seven patients is readmitted within 30 days of discharge following a major surgical procedure. High volume and low mortality hospitals have lower surgical readmissions than other hospitals.