Development, Validation, and Results of a Measure of 30-Day Readmission Following Hospitalization for Pneumonia
Development, Validation, and Results of a Measure of 30-Day Readmission Following Hospitalization for Pneumonia
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DOI：
10.1002/jhm.890
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发表时间：
2011-03-01
影响因子：
2.6
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Lindenauer, Peter K.;Normand, Sharon-Lise T.;Krumholz, Harlan M.
背景技术背景：出院后再入院已成为质量改进的重要目标。目的：描述联邦质量测量和效率倡议中采用的老年肺炎患者再入院率的风险标准化测量的发展、验证和结果。设计：一项回顾性队列研究，使用2005年和2006年的医院和门诊医疗保险索赔。美国共有4675家医院。患者：医疗保险受益人，年龄>65岁，主要出院诊断为肺炎。干预：无。测量：医院特异性，风险标准化30天再入院率，计算为预测与预期再入院率的比值，乘以国家未调整率。比较开发和验证样本中受试者工作曲线下面积（AUC）和相关系数的测量结果：开发样本包括4675家医院的226，545例住院患者，总体未调整的30天再入院率为17.4%。风险标准化的再入院率中位数为17.3%，高于平均水平一个标准差的医院再入院的几率是低于平均水平一个标准差的医院的1.4倍。医疗记录和行政模型的表现相似（AUC曲线下面积分别为0.59和0.63），行政模型和医疗记录模型估计的州特异性标准化再入院率的相关系数为0.96。结论：肺炎治疗后30天内再住院是常见的，各医院的再住院率不同。一个风险标准化的措施，医院再入院率来自行政索赔有类似的性能特点，一个基于病历审查。医院医学杂志2011;6：142-150。(C)2011年医院医学学会2011年医院医学学会DOI 10.1002/jhm.890
BACKGROUND: Readmission following hospital discharge has become an important target of quality improvement.OBJECTIVE: To describe the development, validation, and results of a risk-standardized measure of hospital readmission rates among elderly patients with pneumonia employed in federal quality measurement and efficiency initiatives.DESIGN: A retrospective cohort study using hospital and outpatient Medicare claims from 2005 and 2006.SETTING: A total of 4675 hospitals in the United States.PATIENTS: Medicare beneficiaries aged >65 years with a principal discharge diagnosis of pneumonia.INTERVENTION: None.MEASUREMENTS: Hospital-specific, risk-standardized 30-day readmission rates calculated as the ratio of predicted-to-expected readmissions, multiplied by the national unadjusted rate. Comparison of the areas under the receiver operating curve (AUC) and measurement of correlation coefficient in development and validation samples.RESULTS: The development sample consisted of 226,545 hospitalizations at 4675 hospitals, with an overall unadjusted 30-day readmission rate of 17.4%. The median risk-standardized hospital readmission rate was 17.3%, and the odds of readmission for a hospital one standard deviation above average was 1.4 times that of a hospital one standard deviation below average. Performance of the medical record and administrative models was similar (areas under the AUC curve 0.59 and 0.63, respectively) and the correlation coefficient of estimated state-specific standardized readmission rates from the administrative and medical record models was 0.96.CONCLUSIONS: Rehospitalization within 30 days of treatment for pneumonia is common, and rates vary across hospitals. A risk-standardized measure of hospital readmission rates derived from administrative claims has similar performance characteristics to one based on medical record review. Journal of Hospital Medicine 2011;6:142-150. (C) 2011 Society of Hospital Medicine 2011 Society of Hospital Medicine DOI 10.1002/jhm.890