Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia.
Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia.
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DOI：
10.1001/jama.2013.333
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发表时间：
2013-02-13
影响因子：
120.7
通讯作者：
Normand, Sharon-Lise T.
中科院分区：
文献类型：
--
作者：
Krumholz, Harlan M.;Lin, Zhenqiu;Keenan, Patricia S.;Chen, Jersey;Ross, Joseph S.;Drye, Elizabeth E.;Bernheim, Susannah M.;Wang, Yun;Bradley, Elizabeth H.;Han, Lein F.;Normand, Sharon-Lise T.
医疗保险和医疗补助服务中心公开报告急性心肌梗死（AMI）、心力衰竭（HF）和肺炎的30天全因风险标准化死亡率（RSMRs）和30天全因风险标准化再入院率（RSRR）。用RSMRs和RSRR衡量的医院绩效之间的关系尚未得到很好的表征。我们确定了医院RSMRs和RSRR之间的关系，并在医院特征定义的亚组内。我们研究了2005年7月1日至2008年6月30日期间因AMI、HF或肺炎出院的Medicare按服务收费受益人。我们使用加权线性相关性量化了医院RSMRs和RSRR之间的相关性;评估了由医院特征定义的组中的相关性;并确定了在这两项指标上表现更好和更差的医院比例。医院30天RSMR和RSRR。分析包括4506家AMI医院、4767家HF医院和4811家肺炎医院。AMI、HF和肺炎的平均RSMR和RSRR分别为16.60%和19.94%、11.17%和24.56%、11.64%和18.22%。对于AMI，RSMR和RSRR之间的相关性（95%置信区间[CI]）为0.03（95% CI：-0.002，0.06），对于HF为-0.17（95% CI：-0.20，-0.14），对于肺炎为0.002（95% CI：-0.03，0.03）。按医院特征定义的亚组的结果相似。尽管HF的RSMRs和RSRR之间存在显著的负线性关系，但它们之间的共享方差仅为2.90%（r2 = 0.029）。我们的研究结果并不支持低RSMR的医院一定会有较高的RSRR的担忧。与AMI或肺炎住院患者的发生率无关，与HF住院患者的发生率在一定范围内仅弱相关。
The Centers for Medicare & Medicaid Services publicly reports hospital 30-day all-cause risk-standardized mortality rates (RSMRs) and 30-day all-cause risk-standardized readmission rates (RSRRs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. The relationship between hospital performance as measured by RSMRs and RSRRs has not been well characterized. We determined the relationship between hospital RSMRs and RSRRs overall, and within subgroups defined by hospital characteristics. We studied Medicare fee-for-service beneficiaries discharged with AMI, HF, or pneumonia between July 1, 2005 and June 30, 2008. We quantified the correlation between hospital RSMRs and RSRRs using weighted linear correlation; evaluated correlations in groups defined by hospital characteristics; and determined the proportion of hospitals with better and worse performance on both measures. Hospital 30-day RSMRs and RSRRs. The analyses included 4506 hospitals for AMI; 4767 hospitals for HF; and 4811 hospitals for pneumonia. The mean RSMRs and RSRRs were 16.60% and 19.94% for AMI; 11.17% and 24.56% for HF; and 11.64% and 18.22% for pneumonia. The correlations (95% confidence intervals [CIs]) between RSMRs and RSRRs were 0.03 (95% CI: −0.002, 0.06) for AMI, −0.17 (95% CI: −0.20, −0.14) for HF, and 0.002 (95% CI: −0.03, 0.03) for pneumonia. The results were similar for subgroups defined by hospital characteristics. Although there was a significant negative linear relationship between RSMRs and RSRRs for HF, the shared variance between them was only 2.90% (r2 = 0.029). Our findings do not support concerns that hospitals with lower RSMRs will necessarily have higher RSRRs. The rates are not associated for patients admitted with an AMI or pneumonia and only weakly associated, within a certain range, for patients admitted with HF.
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影响因子：
3.8
作者：
Morrill, R;Cromartie, J;Hart, G
通讯作者：
Hart, G
影响因子：
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作者：
Krumholz, HM;Chen, YT;Horwitz, RI
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影响因子：
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作者：
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Marciniak, TA
DOI：
10.1161/circoutcomes.110.957613
发表时间：
2010-09-01
影响因子：
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作者：
Bernheim, Susannah M.;Grady, Jacqueline N.;Krumholz, Harlan M.
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DOI：
10.1161/circoutcomes.109.883256
发表时间：
2009-09-01
影响因子：
6.9
作者：
Krumholz, Harlan M.;Merrill, Angela R.;Drye, Elizabeth E.
通讯作者：
Drye, Elizabeth E.