Safety-net Hospitals Face More Barriers Yet Use Fewer Strategies to Reduce Readmissions.
Safety-net Hospitals Face More Barriers Yet Use Fewer Strategies to Reduce Readmissions.
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DOI：
10.1097/mlr.0000000000000687
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发表时间：
2017-03
期刊：
影响因子：
3
通讯作者：
Jha AK
中科院分区：
文献类型：
--
作者：
Figueroa JF;Joynt KE;Zhou X;Orav EJ;Jha AK
照顾弱势群体的美国医院，即“安全网医院”(SNH)，更有可能受到医院再入院减少计划 (HRRP) 的处罚，该计划对再入院人数高于预期的医院进行处罚。了解 SNH 是否面临减少再入院的独特障碍，或者他们是否未充分利用再入院预防策略，这一点很重要。我们在 2013 年 6 月至 2014 年 1 月期间对 1,600 家美国急症护理医院的领导层进行了调查，其中 980 家医院参与了调查。对 SNH 和非 SNH 之间关于再入院相关障碍和策略的 28 个问题的回答进行了比较，并调整了不回答和抽样策略。我们进一步比较了高绩效 SNH 和低绩效 SNH 之间的反应。我们的回复率为 62%。与非 SNH 相比，SNH 更有可能报告与患者相关的障碍，包括缺乏交通、无家可归和语言障碍（p 值<0.001）。尽管报告存在更多障碍，SNH 不太可能使用电子工具来分享出院摘要（70.1% vs. 73.7%，p<0.04）或与门诊提供者进行口头交流（31.5% vs. 39.8%，p<0.001）、按种族/民族跟踪再入院情况（23.9% vs. 28.6%，p<0.001）或将患者纳入出院后计划（13.3% vs. 17.2%，p<0.001）。 SNH 也不太可能使用出院协调员、药剂师和出院后计划。当我们检查 SNH 内部策略的使用情况时，我们发现趋势表明，高绩效的 SNH 更有可能使用多种重新入院策略。尽管报告称减少再入院面临更多障碍，但 SNH 不太可能采用减少再入院策略。更高的障碍和更少的策略使用相结合可以解释为什么 SNH 在 HRRP 下有更高的再入院率和处罚率。
U.S. hospitals that care for vulnerable populations, “safety-net hospitals” (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important. We surveyed leadership at 1,600 U.S. acute care hospitals, of whom 980 participated, between June 2013–January 2014. Responses on 28 questions on readmission-related barriers and strategies were compared between SNHs and non-SNHs, adjusting for non-response and sampling strategy. We further compared responses between high-performing SNHs and low-performing SNHs. We achieved a 62% response rate. SNHs were more likely to report patient-related barriers, including lack of transportation, homelessness, and language barriers compared to non-SNHs (p-values<0.001). Despite reporting more barriers, SNHs were less likely to use e-tools to share discharge summaries (70.1% vs. 73.7%, p<0.04) or verbally communicate (31.5% vs. 39.8%, p<0.001) with outpatient providers, track readmissions by race/ethnicity (23.9% vs. 28.6%, p<0.001), or enroll patients in post-discharge programs (13.3% vs. 17.2%, p<0.001). SNHs were also less likely to use discharge coordinators, pharmacists, and post-discharge programs. When we examined the use of strategies within SNHs, we found trends to suggest that high-performing SNHs were more likely to use several readmission strategies. Despite reporting more barriers to reducing readmissions, SNHs were less likely to use readmission-reduction strategies. This combination of higher barriers and lower use of strategies may explain why SNHs have higher rates of readmissions and penalties under the HRRP.