Relative Effects of the Hospital Readmissions Reduction Program on Hospitals That Serve Poorer Patients.
Relative Effects of the Hospital Readmissions Reduction Program on Hospitals That Serve Poorer Patients.
复制标题
减少再入院计划对为贫困患者提供服务的医院的相对影响。
DOI：
10.1097/mlr.0000000000001207
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发表时间：
2019
期刊：
影响因子：
3
通讯作者：
Yeh,RobertW
中科院分区：
文献类型：
--
作者：
Wasfy,JasonH;Bhambhani,Vijeta;Healy,EmmaW;Choirat,Christine;Dominici,Francesca;Wadhera,RishiK;Shen,Changyu;Wang,Yun;Yeh,RobertW
目的：为了比较前后差异的再入院率与不同比例的双重合格患者的医院之间的一般和最高度惩罚（即，低性能）hospital.Design：回顾性队列研究，采用分段线性模型估计医院水平的风险标准化再入院率（RSRR）作为因变量和一个变化点在HRRP通道（2010年）。经济负担通过提供双杀的比例进行评估。设置：美国的急性护理医院。参与者：2003年1月1日至2014年11月30日期间出院的65岁或以上的医疗保险按服务收费受益人，主要出院诊断为急性心肌梗死（AMI）、充血性心力衰竭（CHF）和肺炎。主要结局和测量：在控制了法律前的趋势后，法律后期间医院水平RSRR的下降。结果：对于AMI，双源性高、低比例医院的前后差异不显著（-65 vs.-64风险标准化再入院每10000出院每年，P= 0.0678）。对于CHF，RSRR在高双合格医院比低双合格医院下降得更多（每年每10000例出院患者的风险标准化再入院率为-79 vs.-75，P= 0.0006）。对于肺炎，RSRR在高双合格医院的下降幅度小于低双合格医院（每年每10000例出院患者中的风险标准化再入院率为-44 vs.-47，P= 0.0003）。在742家最高惩罚医院和所有条件中，高双重资格医院的RSRR变化率的前后下降幅度小于低双重资格医院（每年每10000例出院患者中，AMI的风险标准化再入院率为-68 vs.-74，CHF为-88 vs.-97，肺炎为-47 vs.-56，结论和相关性：对于所有医院，RSRR的前后趋势差异随疾病状况而变化。然而，对于最高处罚的医院，在所有处罚条件下，低双重资格医院的RSRR的事后下降幅度大于高双重资格医院。这些结果表明，高惩罚，高双重资格的医院可能不太能够提高再入院指标的性能。
Objective:To compare pre-post differences in readmission rates among hospitals with different proportion of dual-eligible patients both generally and among the most highly penalized (ie, low performing) hospitals.Design:Retrospective cohort study using piecewise linear model with estimated hospital-level risk-standardized readmission rates (RSRRs) as the dependent variable and a change point at HRRP passage (2010). Economic burden was assessed by proportion of dual-eligibles served.Setting:Acute care hospitals within the United States.Participants:Medicare fee-for-service beneficiaries aged 65 years or older discharged alive from January 1, 2003 to November 30, 2014 with a principal discharge diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia.Main Outcome and Measure:Decrease in hospital-level RSRRs in the post-law period, after controlling for the pre-law trend.Results:For AMI, the pre-post difference between hospitals that service high and low proportion of dual-eligibles was not significant (− 65 vs.− 64 risk-standardized readmissions per 10000 discharges per year, P= 0.0678). For CHF, RSRRs declined more at high than low dual-eligible hospitals (− 79 vs.− 75 risk-standardized readmissions per 10000 discharges per year, P= 0.0006). For pneumonia, RSRRs declined less at high than low dual-eligible hospitals (− 44 vs.− 47 risk-standardized readmissions per 10000 discharges per year, P= 0.0003). Among the 742 highest penalized hospitals and all conditions, the pre-post decline in rate of change of RSRRs was less for high dual-eligible hospitals than low dual-eligible hospitals (− 68 vs.− 74 risk-standardized readmissions per 10000 discharges per year for AMI,− 88 vs.− 97 for CHF, and− 47 vs.− 56 for pneumonia, P< 0.0001 for all).Conclusions and Relevance:For all hospitals, differences in pre-post trends in RSRRs varied with disease conditions. However, for the highest-penalized hospitals, the pre-post decline in RSRRs was greater for low than high dual-eligible hospitals for all penalized conditions. These results suggest that high penalty, high dual-eligible hospitals may be less able to improve performance on readmission metrics.