Hospital-Readmission Risk - Isolating Hospital Effects from Patient Effects.
Hospital-Readmission Risk - Isolating Hospital Effects from Patient Effects.
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DOI：
10.1056/nejmsa1702321
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发表时间：
2017-09-14
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影响因子：
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通讯作者：
Normand ST
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文献类型：
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作者：
Krumholz HM;Wang K;Lin Z;Dharmarajan K;Horwitz LI;Ross JS;Drye EE;Bernheim SM;Normand ST
为了隔离医院对医院风险标准化再入院率的影响，我们检查了在给定的一年内在>1家医院因类似诊断多次入院的患者的再入院结局。我们将2014年7月至2015年6月的医疗保险和医疗补助服务中心医院范围内的再入院测量队列分为2个随机样本。我们使用第一个样本来计算每家医院的风险标准化再入院率，并将医院分为绩效四分位数。在第二个样本中，我们确定了在不同医院有2次类似诊断的患者，间隔超过一个月和不到一年，并比较了在不同性能四分位数医院住院的患者的再入院率。在用于表征医院绩效的样本中，风险标准化再入院率中位数为15.5%（IQR 15.3%-15.8%）。另一个样本包括37，508名患者，在4，272家不同的医院有2次类似的诊断。当患者在表现最差的四分位数中入院时，观察到的再入院率始终较高，但当相同患者在表现最好和最差的四分位数中入院时，观察到的唯一统计学显著差异，其中绝对再入院率差异为1.95个百分点（95% CI，0.39%-3.50%）。当相同的患者以相似的诊断入院时，在医院再入院表现最好的四分位数与表现最差的四分位数相比，30天内的再入院率有显著差异。研究结果表明，医院质量有助于部分再入院率独立于病人的因素。
To isolate hospital effects on hospitals’ risk-standardized readmission rates, we examined readmission outcomes among patients with multiple admissions for a similar diagnosis at >1 hospital within a given year. We divided the Centers for Medicare & Medicaid Services hospital-wide readmission measure cohort from July 2014–June 2015 into 2 random samples. We used the first sample to calculate each hospital’s risk-standardized readmission rate and classified hospitals into performance quartiles. In the second sample, we identified patients with 2 admissions for similar diagnoses at different hospitals that occurred more than a month and less than a year apart, and compared observed readmission rates for those admitted to hospitals in different performance quartiles. In the sample used to characterize hospital performance, the median risk-standardized readmission rate was 15.5% (IQR 15.3%–15.8%). The other sample included 37,508 patients with 2 admissions for similar diagnoses at 4,272 different hospitals. The observed readmission rate was consistently higher when patients were admitted to hospitals in the worse performing quartile, but the only statistically significant difference was observed when the same patients were admitted to hospitals in the best and worst performing quartiles, in which the absolute readmission rate difference was 1.95 percentage points (95% CI, 0.39%–3.50%). When the same patients were admitted with similar diagnoses to hospitals in the best performing quartile compared with the worst performing quartile for hospital readmission performance, there is a significant difference in rates of readmission within 30 days. The findings suggest that hospital quality contributes in part to readmission rates independent of patient factors.