Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission
Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission
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DOI：
10.1161/circoutcomes.109.883256
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发表时间：
2009-09-01
影响因子：
6.9
通讯作者：
Drye, Elizabeth E.
中科院分区：
文献类型：
--
作者：
Krumholz, Harlan M.;Merrill, Angela R.;Drye, Elizabeth E.
2009年，医疗保险和医疗补助服务中心公开报告了医院级别的风险标准化急性心肌梗死（AMI）和心力衰竭（HF）后30天死亡率和再入院率。我们提供基于这些措施的医院绩效模式。方法和结果：我们计算了2005年7月至2008年6月期间出院的所有65岁及以上初级诊断为AMI或HF的医疗保险服务收费受益人的30天死亡率和再入院率。我们比较了医院转诊地区和医院结构特征的加权风险标准化死亡率和再入院率。AMI的30天死亡率中位数为16.6%（范围：10.9%至24.9%；25至75百分位，15.8%至17.4%；10至90百分位，14.7%至18.4%），HF的30天死亡率中位数为11.1%（范围：6.6%至19.8%；25至75百分位，10.3%至12.0%；10至90百分位，9.4%至13.1%）。AMI的30天再入院率中位数为19.9%（范围：15.3% ~ 29.4%；25 ~ 75百分位，19.5% ~ 20.4%；10 ~ 90百分位，18.8% ~ 21.1%），HF的30天再入院率中位数为24.4%（范围：15.9% ~ 34.4%；25 ~ 75百分位，23.4% ~ 25.6%；10 ~ 90百分位，22.3% ~ 27.0%）。我们观察到全国各地的表现存在地域差异。虽然各类型医院的平均绩效存在一定差异，但各类型医院均存在高绩效和低绩效之分。结论：在最近3年的时间里，AMI和HF的30天风险标准化死亡率在不同医院和全国范围内有所不同。再入院率特别高。（中国心血管杂志，2009;2:407-413）
Background-In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures.Methods and Results-We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008. We compared weighted risk-standardized mortality and readmission rates across Hospital Referral Regions and hospital structural characteristics. The median 30-day mortality rate was 16.6% for AMI (range, 10.9% to 24.9%; 25th to 75th percentile, 15.8% to 17.4%; 10th to 90th percentile, 14.7% to 18.4%) and 11.1% for HF (range, 6.6% to 19.8%; 25th to 75th percentile, 10.3% to 12.0%; 10th to 90th percentile, 9.4% to 13.1%). The median 30-day readmission rate was 19.9% for AMI (range, 15.3% to 29.4%; 25th to 75th percentile, 19.5% to 20.4%; 10th to 90th percentile, 18.8% to 21.1%) and 24.4% for HF (range, 15.9% to 34.4%; 25th to 75th percentile, 23.4% to 25.6%; 10th to 90th percentile, 22.3% to 27.0%). We observed geographic differences in performance across the country. Although there were some differences in average performance by hospital characteristics, there were high and low hospital performers among all types of hospitals.Conclusions-In a recent 3-year period, 30-day risk-standardized mortality rates for AMI and HF varied among hospitals and across the country. The readmission rates were particularly high. (Circ Cardiovasc Qual Outcomes. 2009;2:407-413.)