Understanding hospital readmission rates: patient, hospital and community effects

描述（由申请人提供）：再入院是常见的，昂贵的，往往对患者有害，但患者，医院和社区因素与医院再入院率的关系尚不清楚。随着减少再入院率的兴趣上升， 了解医院和社区对再入院率的影响的类型和程度，以便确定干预的最佳目标。在全国范围内，人们高度关注降低再入院率和加强护理协调，这是由主要的联邦政策倡议（如医院参与网络、社区护理过渡计划和减少再入院计划）带头的。个别医院也参与当地的努力，最大限度地发挥地区优势，以减少再入院。研究小组此前已经开发了一种新的全条件30天风险标准化的医院范围内的计划外再入院措施。该措施已得到国家质量论坛的认可，并将于2013年由医疗保险公开报道。该测量可用作经验证的风险标准化分析，以比较医院再入院率，同时考虑医院之间诊断和病例组合的差异。此外，该措施是一个复合的五个专业特定的子措施，使我们能够分层的专业结果。我们将使用这种分析来检查医院和社区对再入院率的影响，并研究重大政策变化的影响。具体而言，使用国家医疗保险行政索赔数据，沿着几个补充数据源，我们的目标是：1）确定与再入院率相关的医院和社区特征; 2）确定哪些医院和社区因素与五个临床专业队列中的每一个相关（心血管疾病、心肺疾病、神经系统疾病、其他内科疾病和外科疾病）; 3）描述2007年至2016年期间再入院率的趋势，确定改善与政策变化的关联，并对随着时间的推移变化最大和最小的医院进行深入的定性分析。该提案与AHRQ的几个优先人群相关，包括低收入群体、少数群体、妇女、老年患者和有特殊医疗保健需求的个人，并将提供信息，促进我们对医院再入院的理解，使临床医生、医院和政策制定者能够改善所有患者的医疗保健服务。

DESCRIPTION (provided by applicant): Readmissions are common, costly and often detrimental to patients, yet the relationship of patient, hospital and community factors to hospita readmission rates is unclear. As interest in reducing hospital readmissions rises, it is crucial to understand the type and extent of hospital and community influence on readmission rates so that the best targets for interventions can be identified. Nationally, there is intense focus on reducing readmission rates and in increasing coordination of care, spearheaded by major Federal policy initiatives such as Hospital Engagement Networks, the Community Care Transitions Program, and the Hospital Readmission Reduction Program. Individual hospitals are also engaged in local efforts that maximize area strengths to reduce readmissions. The investigative team has previously developed a new all-condition 30-day risk-standardized hospital-wide unplanned readmission measure. The measure has been endorsed by the National Quality Forum and will be publicly reported by Medicare in 2013. This measure can be used as a validated, risk-standardized assay to compare hospital readmission rates while accounting for differences in diagnoses and case mix among hospitals. Furthermore, the measure is a composite of five specialty-specific sub-measures, allowing us to stratify results by specialty. We will use this assay to examine the influence of hospitals and communities on readmission rates and to study the impact of major policy changes. Specifically, using national Medicare administrative claims data, along with several complementary data sources, our objectives are to: 1) identify characteristics of hospitals and communities associated with readmission rates; 2) determine which hospital and community factors are relevant for each of five clinical specialty cohorts (cardiovascular disease, cardiorespiratory disease, neurological disease, other medical disease, and surgical conditions); and 3) characterize trends in readmission rates between 2007 and 2016, determine the association of improvements with policy changes, and conduct in-depth qualitative analysis of hospitals with greatest and least change over time. This proposal is relevant to several AHRQ priority populations, including low income groups, minority groups, women, older patients, and individuals with special health care needs, and will provide information that advances our understanding of hospital readmissions, enabling clinicians, hospitals, and policymakers to improve healthcare delivery for all patients.