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的自然史被COPD的复发性急性加重打断，这与显著的发病率和医疗保健成本相关。2010年，美国约有699，000例COPD住院治疗，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。为了解决这个高再入院率的问题，医疗保险和医疗补助服务中心（CMS）建议增加30天全因死亡率和COPD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已被授权对最初三次再入院过多的医院进行经济处罚。 自2012年10月1日以来的疾病（急性心肌梗死、心力衰竭和肺炎）。从2015财年开始，该名单将扩大到包括COPD。然而，缺乏关于COPD再入院的研究，例如缺乏经过验证的风险调整模型，以及缺乏关于减少COPD再入院的最佳治疗策略的信息。我们建议汇编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]和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）检查2006-2012年期间因COPD住院后30天再入院率（全因和病因特异性）的国家趋势，包括总体和种族/民族、美国地区、共病数量和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）和临床富集索赔（NHANES-Medicare）的模型;（3）比较开始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种广泛策略，包括8项比较：戒烟（例如，伐尼克兰对安非他酮），疫苗（例如，流感和肺炎球菌）、支气管扩张剂/联合治疗、肺康复和初级保健提供者随访。这项拟议的研究非常重要，因为它解决了COPD再入院CER的临床和方法学方面的问题，这是一个研究不足但非常重要的主题。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，三个新的风险调整/预测模型，以及减少COPD再入院的最佳治疗方案的信息。因此，我们期望这些结果将有助于减少昂贵的再入院，并对患者、家庭成员、临床医生、医疗保险公司、医院管理人员和政策制定者产生重要影响。