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（由申请人提供）：慢性阻塞性肺病 (COPD) 目前是美国第三大死亡原因，在 2008 年超过中风。COPD 的自然病程中不时出现 COPD 反复急性加重的情况，这与显着的发病率和医疗费用有关。 2010年，美国约有699,000名慢性阻塞性肺病患者住院治疗，导致该国的医院费用达到130亿美元。此外，五分之一的住院患者会在出院后 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 天全因死亡率和再入院率，作为新的公开报告的质量指标。此外，根据《平价医疗法案》，CMS 已被授权对重新入院率过高的医院进行经济处罚，最初为 3 次。 自 2012 年 10 月 1 日起，该名单将扩大到包括慢性阻塞性肺病 (COPD)。然而，关于慢性阻塞性肺病再入院的研究匮乏，例如缺乏经过验证的风险调整模型，以及减少慢性阻塞性肺病再入院的最佳治疗策略的信息很少。我们建议编译和分析来自四个来源的国家纵向数据（医疗保健成本和利用项目 [HCUP]、医疗保险索赔/D 部分药物数据、医疗保险当前受益人调查 [MCBS] 以及国家健康和营养检查调查 [NHANES]-医疗保险相关数据），以解决这些知识差距。具体目标是： (1) 研究 2006 年至 2012 年期间因 COPD 住院后 30 天再入院率（全因和特定原因）的全国趋势，包括总体趋势和种族/族裔、美国地区、合并症数量以及 AHRQ 定义的优先人群（例如妇女和老年人）； (2) 开发并验证 30 天全因 COPD 再入院的三种风险调整模型：仅基于行政索赔（Medicare）、调查增强索赔（MCBS）和临床丰富索赔（NHANES-Medicare）的模型； (3) 比较启动指南推荐的干预措施在减少 30 天和 1 年时全因和 COPD 相关再住院的有效性。干预措施将包括 5 项广泛策略，涵盖 8 项比较：戒烟（例如伐尼克兰与安非他酮）、疫苗（例如流感和肺炎球菌）、支气管扩张剂/联合疗法、肺康复以及初级保健提供者的随访。拟议的研究非常重要，因为它解决了 CER 对 COPD 再入院的临床和方法学方面的影响，这是一个尚未得到充分研究但非常重要的主题。该研究将产生新的结果，包括流行病学分析，以确定再入院风险较高的亚群，三种新的风险调整/预测模型，以及减少慢性阻塞性肺病再入院的最佳治疗方案的信息。因此，我们预计研究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。