Reliability of Predicting Early Hospital Readmission After Discharge for an Acute Coronary Syndrome Using Claims-Based Data
Reliability of Predicting Early Hospital Readmission After Discharge for an Acute Coronary Syndrome Using Claims-Based Data
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DOI：
10.1016/j.amjcard.2015.11.034
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发表时间：
2016-02-15
影响因子：
2.8
通讯作者：
Kiefe, Catarina I.
中科院分区：
文献类型：
--
作者：
McManus, David D.;Saczynski, Jane S.;Kiefe, Catarina I.
急性冠脉综合征（包括急性心肌梗死（AMI））出院后早期再住院通常被认为是不可取的。医疗保险和医疗补助服务中心（CMS）将AMI后的风险调整后再入院率作为医院财务激励的基础，并在其调整模型中使用索赔数据。很少有人知道的贡献，再入院风险的因素没有捕获的索赔。对于2011年至2013年从马萨诸塞州和格鲁吉亚的6家医院出院的804例急性冠状动脉综合征后>65岁的连续患者，我们比较了CMS样再入院预测模型与增强模型，该模型在主成分分析后纳入了额外的临床、心理社会和社会人口统计学特征。平均年龄为73岁，38%为女性，25%受过大学教育，32%既往有AMI; 13%的患者在30天内发生全因再住院。在增强模型中;既往冠状动脉介入治疗（比值比[OR] = 2.05，95%可信区间[CI] 1.34 - 3.16;慢性肾脏疾病OR 1.89，95% CI 1.15 - 3.10;健康知识水平低OR 1.75，95% CI 1.14 - 2.69）、较低血清钠水平和当前非吸烟状态与再入院呈正相关。增强型与基于索赔的模型的区分能力更高，没有过度拟合的证据。例如，对于再入院可能性最高的十分位数的患者，基于索赔的模型观察到的再入院发生率为24%，增强模型为33%。总之，再入院可能会受到CMS基于索赔的模型中不可测量因素的影响，并且医院无法控制。在风险调整再入院模型中加入其他因素，可以提高其作为医院质量指标的准确性和有效性。(C)2016 Elsevier Inc. All rights reserved.
Early rehospitalization after discharge for an acute coronary syndrome, including acute myocardial infarction (AMI), is generally considered undesirable. The Centers for Medicare and Medicaid Services (CMS) base hospital financial incentives on risk-adjusted read-mission rates after AMI, using claims data in its adjustment models. Little is known about the contribution to readmission risk of factors not captured by claims. For 804 consecutive patients >65 years discharged in 2011 to 2013 from 6 hospitals in Massachusetts and Georgia after an acute coronary syndrome, we compared a CMS-like readmission prediction model with an enhanced model incorporating additional clinical, psychosocial, and sociodemographic characteristics, after principal components analysis. Mean age was 73 years, 38% were women, 25% college educated, and 32% had a previous AMI; all-cause rehospitalization occurred within 30 days for 13%. In the enhanced model; previous coronary intervention (odds ratio [OR] = 2.05, 95% confidence interval [CI] 1.34 to 3.16; chronic kidney disease OR 1.89, 95% CI 1.15 to 3.10; low health literacy OR 1.75, 95% CI 1.14 to 2.69), lower serum sodium levels, and current nonsmoker status were positively associated with readmission. The discriminative ability of the enhanced versus the claims based,model was higher without evidence of overfitting. For example, for patients in the highest deciles of readmission likelihood, observed readmissions occurred in 24% for the claims-based model and 33% for the enhanced model. In conclusion, readmission may be influenced by measurable factors not in CMS' claims-based models and not controllable by hospitals. Incorporating additional factors into risk-adjusted readmission models may improve their accuracy and validity for use as indicators of hospital quality. (C) 2016 Elsevier Inc. All rights reserved.