National Patterns of Risk-Standardized Mortality and Readmission for Acute Myocardial Infarction and Heart Failure Update on Publicly Reported Outcomes Measures Based on the 2010 Release
National Patterns of Risk-Standardized Mortality and Readmission for Acute Myocardial Infarction and Heart Failure Update on Publicly Reported Outcomes Measures Based on the 2010 Release
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DOI：
10.1161/circoutcomes.110.957613
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发表时间：
2010-09-01
影响因子：
6.9
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Bernheim, Susannah M.;Grady, Jacqueline N.;Krumholz, Harlan M.
背景-患者结局为护理质量提供了重要视角。医疗保险和医疗补助服务中心（CMS）公开报告急性心肌梗死（AMI）和心力衰竭（HF）住院患者的医院30天风险标准化死亡率（RSMRs）和风险标准化再入院率（RSRR）。我们提供了一个国家的角度对医院的性能为2010年发布这些measures.Methods和Results-the医院RSMRs和RSRR计算从医疗保险索赔数据为收费服务的医疗保险受益人，65岁或以上，2006年7月1日和2009年6月30日之间住院的AMI或HF。使用分层逻辑模型计算发生率，以解释患者聚类，并根据年龄、性别和患者合并症进行风险调整。AMI和HF的中位RSMR分别为16.0%和10.8%。两项指标的医院表现范围很广，AMI的第5百分位数与第95百分位数的医院间绝对差异为5.2%，HF为5.0%。AMI的中位RSRR为19.9%，HF为24.5%（AMI的第5至第95百分位数范围为3.9%，HF为6.7%）。两种措施和两个conditions. Conclusions高RSRR持续AMI和HF和临床有意义的变化存在RSMRs和RSRR的两种条件下，明显的区域模式。我们的研究结果表明，持续的机会，改善患者的结果为HF和AMI。(Circ血管定性结局。2010; 3：459-467）。
Background-Patient outcomes provide a critical perspective on quality of care. The Centers for Medicare and Medicaid Services (CMS) is publicly reporting hospital 30-day risk-standardized mortality rates (RSMRs) and risk-standardized readmission rates (RSRRs) for patients hospitalized with acute myocardial infarction (AMI) and heart failure (HF). We provide a national perspective on hospital performance for the 2010 release of these measures.Methods and Results-The hospital RSMRs and RSRRs are calculated from Medicare claims data for fee-for-service Medicare beneficiaries, 65 years or older, hospitalized with AMI or HF between July 1, 2006, and June 30, 2009. The rates are calculated using hierarchical logistic modeling to account for patient clustering, and are risk-adjusted for age, sex, and patient comorbidities. The median RSMR for AMI was 16.0% and for HF was 10.8%. Both measures had a wide range of hospital performance with an absolute 5.2% difference between hospitals in the 5th versus 95th percentile for AMI and 5.0% for HF. The median RSRR for AMI was 19.9% and for HF was 24.5% (3.9% range for 5th to 95th percentile for AMI, 6.7% for HF). Distinct regional patterns were evident for both measures and both conditions.Conclusions-High RSRRs persist for AMI and HF and clinically meaningful variation exists for RSMRs and RSRRs for both conditions. Our results suggest continued opportunities for improvement in patient outcomes for HF and AMI. (Circ Cardiovasc Qual Outcomes. 2010; 3:459-467.)