Resurrecting immortal-time bias in the study of readmissions
Resurrecting immortal-time bias in the study of readmissions
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DOI：
10.1111/1475-6773.13252
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发表时间：
2019-12-26
影响因子：
3.4
通讯作者：
Jacobs, Bruce L.
中科院分区：
文献类型：
--
作者：
Hugar, Lee A.;Borza, Tudor;Jacobs, Bruce L.
目的比较美国医疗保险和医疗补助服务中心与美国外科医师学会国家手术质量改进计划（NSQIP）方法测量的再入院率。数据来源：2010年至2014年间接受膀胱切除术、结肠切除术、腹主动脉瘤（AAA）修复和全膝关节置换术（TKA）患者的20%的国家医疗保险数据样本。研究设计比较30天再入院率的回顾性队列研究。数据收集/提取方法选取2010 - 2014年间接受膀胱切除术、结肠切除术、腹主动脉瘤修复术和全膝关节置换术的患者。主要发现膀胱切除术的再入院率最高，全膝关节置换术的再入院率最低。与CMS方法相比，NSQIP方法报告的所有程序的发生率明显较低，这反映了一种不朽的时间偏差。结论：在比较CMS和NSQIP措施时，我们发现所有外科手术的再入院率存在显著差异。更长的停留时间加剧了这些差异。需要统一的结果衡量标准，以消除歧义，协同研究和政策努力。
Objective To compare readmission rates as measured by the Centers for Medicare and Medicaid Services and the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) methods. Data Sources 20 percent sample of national Medicare data for patients undergoing cystectomy, colectomy, abdominal aortic aneurysm (AAA) repair, and total knee arthroplasty (TKA) between 2010 and 2014. Study Design Retrospective cohort study comparing 30-day readmission rates. Data Collection/Extraction Methods Patients undergoing cystectomy, colectomy, abdominal aortic aneurysm repair, and total knee arthroplasty between 2010 and 2014 were identified. Principal Findings Cystectomy had the highest and total knee arthroplasty had the lowest readmission rate. The NSQIP measure reported significantly lower rates for all procedures compared to the CMS measure, which reflects an immortal-time bias. Conclusions We found significantly different readmission rates across all surgical procedures when comparing CMS and NSQIP measures. Longer length of stay exacerbated these differences. Uniform outcome measures are needed to eliminate ambiguity and synergize research and policy efforts.