An Administrative Claims Measure Suitable for Profiling Hospital Performance on the Basis of 30-Day All-Cause Readmission Rates Among Patients With Heart Failure
An Administrative Claims Measure Suitable for Profiling Hospital Performance on the Basis of 30-Day All-Cause Readmission Rates Among Patients With Heart Failure
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DOI：
10.1161/circoutcomes.108.802686
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发表时间：
2008-09-01
影响因子：
6.9
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Keenan, Patricia S.;Normand, Sharon-Lise T.;Krumholz, Harlan M.
背景-对于心力衰竭患者来说，出院后不久再次入院是一种昂贵且通常可以预防的事件。我们提出了一个由国家质量论坛批准的模型，目的是由医疗保险和医疗补助服务中心的医院级再入院率的公开报告。方法和结果-我们开发了一个分层逻辑回归模型来计算医院的风险标准化30天的全因再入院率心力衰竭住院患者。该模型是使用2004年队列的医疗保险索赔数据得出的，并使用索赔和医疗记录数据进行验证。未调整的再入院率为23.6%。最终模型包括37个变量，具有从最低预测十分位数中观察到的30天再入院率的15%到最高十分位数中的37%的区分度，并且具有0.60的c统计量。4669家医院的风险标准化再入院率的第25和第75位分别为23.1%和24.0%，第5和第95位分别为22.2%和25.1%。高于平均值1个标准差的医院的全因再入院几率是低于平均值1个标准差的医院的1.30倍。使用索赔模型得出的州一级调整后的再入院率与使用病历模型得出的同一队列的再入院率相似（相关系数0.97;中值差，0.06个百分点）。结论-这种基于索赔的医院风险模型-心力衰竭患者的标准化再入院率产生的估计值可以作为从医疗记录模型导出的估计值的替代。（循环血管质量结局。2008;1：29-37.）
Background-Readmission soon after hospital discharge is an expensive and often preventable event for patients with heart failure. We present a model approved by the National Quality Forum for the purpose of public reporting of hospital-level readmission rates by the Centers for Medicare & Medicaid Services.Methods and Results-We developed a hierarchical logistic regression model to calculate hospital risk-standardized 30-day all-cause readmission rates for patients hospitalized with heart failure. The model was derived with the use of Medicare claims data for a 2004 cohort and validated with the use of claims and medical record data. The unadjusted readmission rate was 23.6%. The final model included 37 variables, had discrimination ranging from 15% observed 30-day readmission rate in the lowest predictive decile to 37% in the upper decile, and had a c statistic of 0.60. The 25th and 75th percentiles of the risk-standardized readmission rates across 4669 hospitals were 23.1% and 24.0%, with 5th and 95th percentiles of 22.2% and 25.1%, respectively. The odds of all-cause readmission for a hospital 1 standard deviation above average was 1.30 times that of a hospital 1 standard deviation below average. State-level adjusted readmission rates developed with the use of the claims model are similar to rates produced for the same cohort with the use of a medical record model (correlation, 0.97; median difference, 0.06 percentage points).Conclusions-This claims-based model of hospital risk-standardized readmission rates for heart failure patients produces estimates that may serve as surrogates for those derived from a medical record model. ( Circ Cardiovasc Qual Outcomes. 2008;1:29-37.)