Public Reporting of Mortality Rates for Hospitalized Medicare Patients and Trends in Mortality for Reported Conditions.
Public Reporting of Mortality Rates for Hospitalized Medicare Patients and Trends in Mortality for Reported Conditions.
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DOI：
10.7326/m15-1462
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发表时间：
2016-08-02
影响因子：
39.2
通讯作者：
Jha AK
中科院分区：
文献类型：
--
作者：
Joynt KE;Orav EJ;Zheng J;Jha AK
公开报告被视为一种强有力的质量改进工具，但支持其效力的数据有限。医疗保险和医疗补助服务中心的医院比较计划最初仅报告流程指标，但于2008年开始报告急性心肌梗死、心力衰竭和肺炎的死亡率。确定公共报告的死亡率是否与医疗保险受益人中这些疾病的较低死亡率相关。2005年至2007年，考虑了仅报告过程; 2008年至2012年，考虑了报告过程和死亡率。使用患者水平分层模型估计报告期前和报告期内死亡率趋势的变化。未报告的医疗条件被用作长期对照。美国急性护理医院2005年1月至2012年11月期间住院的20 707 266名按服务收费的医疗保险受益人。30-日风险调整死亡率。在仅过程报告期间，3种公开报告疾病的死亡率以每季度-0.23%的绝对速率变化，但在过程和死亡率报告期间，这种变化减缓至每季度-0.09%的速率（变化，每季度0.13%; 95%CI，0.12%至0.14%）。在仅过程报告期间，未报告疾病的死亡率每季度变化为-0.17%，在过程和死亡率报告期间每季度略微放缓至-0.11%（变化，每季度0.06%; CI，0.05%至0.07%）。管理数据可能具有有限的能力来解释患者复杂性随时间的变化。死亡率趋势的变化表明，医院比较报告与医疗保险患者死亡率持续下降的放缓有关，而不是改善。国家心肺血液研究所。
Public reporting is seen as a powerful quality improvement tool, but data to support its efficacy are limited. The Centers for Medicare & Medicaid Services’ Hospital Compare program initially reported process metrics only but started reporting mortality rates for acute myocardial infarction, heart failure, and pneumonia in 2008. To determine whether public reporting of mortality rates was associated with lower mortality rates for these conditions among Medicare beneficiaries. For 2005 to 2007, process-only reporting was considered; for 2008 to 2012, process and mortality reporting was considered. Changes in mortality trends before and during reporting periods were estimated by using patient-level hierarchical modeling. Nonreported medical conditions were used as a secular control. U.S. acute care hospitals. 20 707 266 fee-for-service Medicare beneficiaries hospitalized from January 2005 through November 2012. 30-day risk-adjusted mortality rates. Mortality rates for the 3 publicly reported conditions were changing at an absolute rate of −0.23% per quarter during process-only reporting, but this change slowed to a rate of −0.09% per quarter during process and mortality reporting (change, 0.13% per quarter; 95% CI, 0.12% to 0.14%). Mortality for nonreported conditions was changing at −0.17% per quarter during process-only reporting and slowed slightly to −0.11% per quarter during process and mortality reporting (change, 0.06% per quarter; CI, 0.05% to 0.07%). Administrative data may have limited ability to account for changes in patient complexity over time. Changes in mortality trends suggest that reporting in Hospital Compare was associated with a slowing, rather than an improvement, in the ongoing decline in mortality among Medicare patients. National Heart, Lung, and Blood Institute.