Investigating the Appropriateness of 30-Day Rehospitalizations in Dialysis Patients

调查透析患者 30 天再住院的适当性

• 批准号: 9131964
• 负责人: Eugene Lin
• 金额: $ 7.35万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-20 至 2018-07-19
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9131964
• 关键词: Accounting; Adverse event; Cardiovascular system; Categories; Catheters; Cessation of life; Characteristics; Clinical; Comorbidity; Death Rate; Diagnosis; Dialysis patients; Dialysis procedure; End stage renal failure; Future; Grant; Group Hospitalization; Health; Heart failure; Hemorrhage; Hospitalization; Hospitals; Internal Medicine; Internships; Journals; Lead; Life; Manuscripts; Medical; Medicare; Nephrology; Outcome; Patients; Persons; Physicians; Policies; Policy Maker; Population; Research; Risk; Subgroup; Therapeutic; United States Centers for Medicare and Medicaid Services; beneficiary; experience; gastrointestinal infection; high risk; hospital readmission; indexing; mortality; patient stratification; prevent; public health relevance

 DESCRIPTION (provided by applicant): Patients with end stage renal disease (ESRD) constitute a small percentage of Medicare beneficiaries but account for a disproportionate amount of the money spent on Medicare. They are rehospitalized far more frequently than other persons, with 36% of patients rehospitalized within 30 days. As the Centers for Medicare and Medicaid Services (CMS) have increasingly focused on reducing 30-day hospital readmission rates in all Medicare patients including those on dialysis, they have started penalizing hospitals for 30-day readmissions. Even though physicians are increasingly incentivized to avoid 30-day rehospitalizations, it is not known if they are preventable in patients on dialysis (or in Medicare patients as a whole) or if some rehospitalizations are potentially beneficial. The causes of 30-day readmissions in patients on dialysis have not been previously described, and to date, no one has attempted to see if some 30-day rehospitalizations might prevent future adverse events in patients. The First Aim is mostly descriptive and will identify the most common hospitalization and rehospitalization pairs of diagnoses. It will also identify diagnosis pairs that are clinically related to each other and those that are not. The Second Aim will take the most common causes of 30-day rehospitalization and identify groups of patients who are likely to be rehospitalized and those who are likely to die within 3 years, in order to risk-stratify patients b mortality and likelihood for rehospitalization. The Third Aim will take patients who are at high likelihood for death and identify groups of patients who may potentially benefit from 30-day readmission by seeing if they have better outcomes than expected. This research will help clinicians and policy makers better understand when 30-day rehospitalizations may be beneficial to patients on dialysis. It will help direct policy makers to introduce policies that taget reductions in "inappropriate rehospitalizations" and will help physicians understand when to consider rehospitalization as a potential therapeutic treatment.

 描述（由适用提供）：患有终阶段肾脏疾病（ESRD）的患者占医疗保险受益人的一小部分，但占医疗保险花费的金钱不成比例。他们的重新住院频率要比其他人更频繁，其中36％的患者在30天内重新住院。随着医疗保险和医疗补助服务中心（CMS）的重点越来越集中于降低包括透析患者在内的所有医疗保险患者的30天医院再入院率，他们已经开始对30天的再入院率进行处罚。即使越来越激励医生以避免30天的复兴化，但尚不清楚透析患者是否可以预防（或Medicare中的患者） 整个患者）或某些重新住院是否有益。先前尚未描述过透析患者30天再入院的原因，迄今为止，没有人试图查看是否有30天的重新住院化是否可能阻止患者未来的广告事件。第一个目的主要是描述性的，将确定最常见的住院和重新住院诊断对。它还将识别临床上的诊断对 彼此相关，与那些无关。第二个目标将是30天重新授课的最常见原因，并确定可能会重新住院的患者组，并且可能在3年内死亡的患者，以便将患者b死亡率和重新寄养的可能性造成风险分解。第三个目标将使死亡可能性很高的患者通过查看是否有比预期更好的结果来识别有可能从30天重新入院中受益的患者。这项研究将帮助临床医生和政策制定者更好地了解30天的重新住院何时可能对透析患者有益。它将有助于指导政策制定者引入政策，以减少“不适当的再住院化”，并帮助医生了解何时将重新寄养性视为潜在的治疗疗法。