Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization
Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization
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DOI：
10.1097/mlr.0000000000000882
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发表时间：
2018-04-01
期刊：
影响因子：
3
通讯作者：
Herrin, Jeph
中科院分区：
文献类型：
--
作者：
Horwitz, Leora, I;Wang, Yongfei;Herrin, Jeph
背景：不知道再住院率高的医院是否也有较高的出院后急性护理利用率(包括急诊科和观察护理)。设计：横断面分析。主题：非联邦美国急性护理医院。测量：使用医疗保险和医疗补助服务中心建立的方法，我们计算了每家医院因急性心肌梗死、心力衰竭(HF)或肺炎住院后出院后65岁以上的医疗保险受益人的“急性护理过剩天数”，即每100次出院后30天内预计和预期的急性护理利用总天数之间的平均差异。我们评估了8个医院特征与急性护理超额天数的多变量关联，以及每个特征的医院作为统计异常值的比例(95%的可信区间估计不包括0)。结果：我们纳入了2184家急性心肌梗死医院[228家(10.4%)好于预期，549家(25.1%)差]，3720家医院的心衰[484家(13.0%)好和840家(22.6%)差]，4195家医院的肺炎[673家(16.0%)好于预期，1005家(24.0%)差]。所有条件的结果都是相似的。比预期更糟糕的肺炎异常值包括：18.8%的安全网医院和26.1%的非安全网医院；16.7%的公立医院和33.1%的营利性医院；19.5%的非教学医院和52.2%的主要教学医院；7.9%的乡村医院和42.1%的大型城市医院；5.9%的医院有24&50张床位，而58%的医院有500张床位；29.0%的医院有护士床位比；1.0-1.5比21.7%。结论：在主要的教学医院、城市医院和营利性医院中，将急诊科和观察室包括在出院后利用的衡量标准中所产生的结果与仅衡量再入院的结果相似，与非教学或公立医院相比，表现仍然不成比例地差。然而，它可以识别更多的异常值，并对医院因素和结果的相关性进行更细粒度的评估。
Background: Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown.Design: Cross-sectional analysis.Subjects: Nonfederal United States acute care hospitals.Measures: Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital's " excess days in acute care" for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges. We assessed the multivariable association of 8 hospital characteristics with excess days in acute care and the proportion of hospitals with each characteristic that were statistical outliers (95% credible interval estimate does not include 0).Results: We included 2184 hospitals for acute myocardial infarction [228 (10.4%) better than expected, 549 (25.1%) worse than expected], 3720 hospitals for HF [484 (13.0%) better and 840 (22.6%) worse], and 4195 hospitals for pneumonia [673 (16.0%) better, 1005 (24.0%) worse]. Results for all conditions were similar. Worse than expected outliers for pneumonia included: 18.8% of safety net hospitals versus 26.1% of nonsafety net hospitals; 16.7% of public hospitals versus 33.1% of for-profit hospitals; 19.5% of nonteaching hospitals versus 52.2% of major teaching hospitals; 7.9% of rural hospitals versus 42.1% of large urban hospitals; 5.9% of hospitals with 24-< 50 beds versus 58% of hospitals with > 500 beds; and 29.0% of hospitals with nurse-to-bed ratios > 1.0-1.5 versus 21.7% of hospitals with ratios > 2.0.Conclusions: Including emergency department and observation stays in measures of postdischarge utilization produces similar results as measuring only readmissions in that major teaching, urban and for-profit hospitals still perform disproportionately poorly versus nonteaching or public hospitals. However, it enables identification of more outliers and a more granular assessment of the association of hospital factors and outcomes.