Comparative Effectiveness Research on Hospital Readmissions for COPD

慢性阻塞性肺病再入院的比较效果研究

• 批准号: 8885175
• 负责人: CARLOS A. CAMARGO
• 金额: $ 23.55万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8885175
• 关键词: Comparative; Effectiveness; Research; Hospital; Readmissions

 DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death in the United States, surpassing stroke in 2008. The natural history of COPD is punctuated by recurrent acute exacerbations of COPD, which are associated with significant morbidity and healthcare costs. In 2010, there were about 699,000 COPD hospitalizations in the US, costing the nation $13 billion dollars in hospital bills. Furthermore, 1 in 5 hospitalizations is followed by a readmission within 30 days of discharge. To address this high-readmission issue, the Centers for Medicare and Medicaid Services (CMS) is proposing to add 30-day all-cause mortality and readmission rates for COPD as new publicly-reported quality measures. In addition, under the Affordable Care Act, CMS has been authorized to financially penalize hospitals for excessive readmissions for an initial set of three conditions (acute myocardial infarction, heart failure, and pneumonia) since October 1, 2012. Beginning in fiscal year 2015, the list will expand to include COPD. However, there is a dearth of research on COPD readmission, such as lack of a validated risk-adjustment model and scant information on best treatment strategies to reduce COPD readmissions. We propose to compile and analyze national, longitudinal data from four sources (the Healthcare Cost and Utilization Project [HCUP], the Medicare Claims/Part D drug data, the Medicare Current Beneficiary Survey [MCBS], and the National Health and Nutrition Examination Survey [NHANES]-Medicare linked data) to address these knowledge gaps. The Specific Aims are: (1) To examine national trends in 30-day readmission rates (all-cause and cause-specific) after hospitalization for COPD during 2006-2012, both overall and by race/ethnicity, US regions, number of comorbid conditions, and AHRQ- defined priority populations (e.g., women and the elderly); (2) To develop and validate three risk-adjustment models for 30-day all-cause COPD readmission: models based on administrative claims alone (Medicare), survey-enhanced claims (MCBS), and clinically-enriched claims (NHANES-Medicare); (3) To compare the effectiveness of initiation of guideline-recommended interventions in reducing all-cause and COPD-related rehospitalizations at 30 days and 1 year. The interventions will include 5 broad strategies encompassing 8 comparisons: smoking cessation (e.g., varenicline vs. bupropion), vaccines (e.g., influenza and pneumococcal), bronchodilators/combination therapies, pulmonary rehabilitation, and follow-up with a primary care provider. The proposed study is highly significant because it addresses both clinical and methodological aspects of CER on COPD readmission, an understudied but very important topic. The study will generate novel results including epidemiologic analysis to identify subpopulations at higher risk for readmissions, three new risk-adjustment/prediction models, and information on best treatment options in reducing COPD readmissions. Accordingly, we expect that the results will help reduce costly readmissions and have important implications for patients, family members, clinicians, health insurers, hospital administrators, and policymakers.

 描述(申请人提供)：慢性阻塞性肺疾病(COPD)现在是美国第三大死亡原因，在2008年超过了中风。COPD的自然病史中不时会出现COPD的反复急性加重，这与显著的发病率和医疗费用有关。2010年，美国约有69.9万人因慢性阻塞性肺病住院，花费了130亿美元的医院账单。此外，五分之一的住院患者在出院后30天内再次入院。为了解决这一高再入院率问题，医疗保险和医疗补助服务中心(CMS)提议增加COPD的30天全因死亡率和再住院率，作为新的公开报告的质量指标。此外，根据《平价医疗法案》，CMS已被授权对再次入院时间过长的医院进行经济处罚，最初三人一组 自2012年10月1日以来出现的疾病(急性心肌梗死、心力衰竭和肺炎)。从2015财年开始，这份名单将扩大到包括慢性阻塞性肺病。然而，缺乏关于COPD再入院的研究，例如缺乏有效的风险调整模型，以及缺乏关于减少COPD再入院的最佳治疗策略的信息。我们建议从四个来源(医疗保健成本和利用项目[HCUP]、联邦医疗保险索赔/D部分药物数据、联邦医疗保险当前受益人调查[MCBS]和国家健康和营养检查调查[NHANES]-联邦医疗保险关联数据)汇编和分析全国性的纵向数据，以弥补这些知识差距。具体目标是：(1)检查2006-2012年期间COPD住院后30天再住院率(所有原因和具体原因)的全国趋势，包括总体和按种族/民族、美国地区、共病人数和AHRQ定义的优先人群(例如妇女和老年人)；(2)为30天全原因COPD再入院开发和验证三个风险调整模型：仅基于行政索赔的模型(Medicare)、调查强化索赔(MCBS)和临床丰富的索赔(NHANES-Medicare)；(3)比较启动指南建议的干预措施在减少30天和1年的全因和COPD相关再住院方面的有效性。干预措施将包括5项广泛的战略，包括8项比较：戒烟(例如，varenicline与安非他酮)、疫苗(例如，流感和肺炎球菌)、支气管扩张剂/综合疗法、肺康复以及与初级保健提供者的后续行动。这项拟议的研究具有非常重要的意义，因为它涉及慢性阻塞性肺疾病再入院的CER的临床和方法学方面，这是一个研究不足但非常重要的主题。这项研究将产生新的结果，包括流行病学分析，以确定再次住院的高风险亚群，三个新的风险调整/预测模型，以及关于减少COPD再次住院的最佳治疗选择的信息。因此，我们预计这一结果将有助于减少昂贵的再入院费用，并对患者、家庭成员、临床医生、健康保险公司、医院管理人员和政策制定者产生重要影响。