Reply: chronic obstructive pulmonary disease readmissions and medicare reimbursement.
Reply: chronic obstructive pulmonary disease readmissions and medicare reimbursement.
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回复：慢性阻塞性肺疾病再入院和医疗报销。
DOI：
10.1164/rccm.201404-0635le
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发表时间：
2014
影响因子：
24.7
通讯作者：
Au,DavidH
中科院分区：
文献类型：
--
作者：
Feemster,LauraC;Au,DavidH
出于我们文章中概述的原因，我们认为目前的证据不足以证明在COPD恶化后使用30天全原因再入院作为惩罚医院的问责措施是合理的。我们同意Chassin和他的同事所描述的概念框架，即要将一项措施用于问责，而不是作为一项潜在的质量指标，必须将该措施与预期成果之间的关系紧密联系在一起(2)。医院再入院责任措施没有达到这一门槛。正如埃德尔曼博士指出的那样，仍有一些医院无法控制的问题(如空气质量)会增加患者在COPD加重后重新入院的可能性，但这些问题并未计入根据医院再入院减少计划计算的风险调整后的再住院率。将慢性阻塞性肺疾病纳入医院再入院减少计划使全国对这种长期被忽视的疾病产生了更多的关注，这可能是新的问责措施可能带来的好处。我们继续支持卫生保健机构和系统使用再入院变化的数据，为针对COPD的质量改进倡议提供信息。我们仍然希望，对COPD的这种关注将导致发现以证据为基础的干预措施，减少病情恶化和住院人数，并改善数百万患有这种毁灭性疾病的美国人的生活质量。
For the reasons outlined within our article, we believe the current evidence is insufficient to justify the use of 30-day all-cause readmission after COPD exacerbation as an accountability measure to penalize hospitals. We agree with conceptual framework, as described by Chassin and colleagues, that for a measure to be used for accountability, in contrast to being a potential indicator of quality, the relationship between the measure and desired outcome need to be tightly linked (2). The hospital readmission accountability measure does not achieve that threshold. As Dr. Edelman points out, there remain a number of issues that are outside of a hospital’s control (such as air quality) that contribute to the likelihood that a patient will be readmitted after an exacerbation of COPD, yet are not accounted for within the risk-adjusted readmission rates calculated under the Hospital Readmission Reduction Program. Inclusion of COPD in the Hospital Readmission Reduction Program has brought significantly more national attention to this longunderrepresented condition, a possible benefit that may come from the new accountability measure. We continue to support having health care facilities and systems use data on variation in readmission to inform quality improvement initiatives targeting COPD. We also remain hopeful that this attention to COPD will result in the discovery of evidence-based interventions that decrease exacerbations and hospital admissions and improve the quality of life for the millions of Americans with this devastating disease.■