Achieving Equity in Hospital Performance Assessments Using Composite Race-Specific Measures of Risk-Standardized Readmission and Mortality Rates for Heart Failure.
Achieving Equity in Hospital Performance Assessments Using Composite Race-Specific Measures of Risk-Standardized Readmission and Mortality Rates for Heart Failure.
复制标题
使用针对心力衰竭的风险标准化再入院率和死亡率的复合种族特定指标，实现医院绩效评估的公平性。
DOI：
10.1161/circulationaha.122.061995
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发表时间：
2023
期刊：
影响因子：
37.8
通讯作者：
Pandey,Ambarish
中科院分区：
文献类型：
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作者：
Mentias,Amgad;Peterson,EricD;Keshvani,Neil;Kumbhani,DharamJ;Yancy,ClydeW;Morris,AlannaA;Allen,LarryA;Girotra,Saket;Fonarow,GreggC;Starling,RandallC;Alvarez,Paulino;Desai,MilindY;Cram,Peter;Pandey,Ambarish
研究背景：目前衡量心力衰竭住院治疗的医院绩效、30天风险标准化再入院率（RSRR）和风险标准化死亡率（RSMR）的方法是使用相同的风险调整模型和所有患者的总体事件发生率进行估计。因此，这些措施主要是由大多数种族和族裔群体的护理质量和结果驱动，可能无法充分代表医院的黑人和其他种族的患者的表现。MethodsFee-for-service Medicare受益人从2014年1月至2019年12月因心力衰竭住院。使用传统的人种不可知模型和人种特异性方法估计医院水平的30天RSRR和RSMR。复合人种特异性性能指标计算为每个人种和种族组单独得出的RSRR/RMSR测量值的平均值。使用复合种族特异性和种族不可知指标评估所有患者以及黑人和其他种族患者的医院绩效的相关性和一致性。（75.7%白色[n=1 439 958]; 14.5%黑人[n=276 684];和9.8%其他种族[n=186 590]）来自1860家医院的心力衰竭患者。白色患者与黑人患者的医院级30天性能指标之间存在中度相关性（Pearson相关系数：RSRR=0.42; RSMR=0.26）。与人种不可知的RSRR和RSMR相比，所有患者的复合人种特异性指标与黑人患者的RSRR（相关系数：0.60 vs 0.74）和RSMR（相关系数：0.44 vs 0.51）具有更强的相关性。所有患者和黑人患者的医院性能一致性也更高，具有种族特异性（与种族不可知）指标（RSRR=64%与53%一致高性能; 61%与51%一致低性能）。种族特定的RSRR和RSMR指标（相对于种族不可知）分别导致35.8%和39.2%的医院在性能排名中重新分类，在重新分类为高性能的医院中，所有种族组的患者的30天和1年结局更好。种族特异性30天RSMR和RSRR在代表黑人和其他种族患者的医院绩效方面更公平。
BackgroundThe contemporary measures of hospital performance for heart failure hospitalization and 30-day risk-standardized readmission rate (RSRR) and risk-standardized mortality rate (RSMR) are estimated using the same risk adjustment model and overall event rate for all patients. Thus, these measures are mainly driven by the care quality and outcomes for the majority racial and ethnic group, and may not adequately represent the hospital performance for patients of Black and other races.MethodsFee-for-service Medicare beneficiaries from January 2014 to December 2019 hospitalized with heart failure were identified. Hospital-level 30-day RSRR and RSMR were estimated using the traditional race-agnostic models and the race-specific approach. The composite race-specific performance metric was calculated as the average of the RSRR/RMSR measures derived separately for each race and ethnicity group. Correlation and concordance in hospital performance for all patients and patients of Black and other races were assessed using the composite race-specific and race-agnostic metrics.ResultsThe study included 1 903 232 patients (75.7% White [n=1 439 958]; 14.5% Black [n=276 684]; and 9.8% other races [n=186 590]) with heart failure from 1860 hospitals. There was a modest correlation between hospital-level 30-day performance metrics for patients of White versus Black race (Pearson correlation coefficient: RSRR=0.42; RSMR=0.26). Compared with the race-agnostic RSRR and RSMR, composite race-specific metrics for all patients demonstrated stronger correlation with RSRR (correlation coefficient: 0.60 versus 0.74) and RSMR (correlation coefficient: 0.44 versus 0.51) for Black patients. Concordance in hospital performance for all patients and patients of Black race was also higher with race-specific (versus race-agnostic) metrics (RSRR=64% versus 53% concordantly high-performing; 61% versus 51% concordantly low-performing). Race-specific RSRR and RSMR metrics (versus race-agnostic) led to reclassification in performance ranking of 35.8% and 39.2% of hospitals, respectively, with better 30-day and 1-year outcomes for patients of all race groups at hospitals reclassified as high-performing.ConclusionsAmong patients hospitalized with heart failure, race-specific 30-day RSMR and RSRR are more equitable in representing hospital performance for patients of Black and other races.