Investigating the Appropriateness of 30-Day Rehospitalizations in Dialysis Patients

 描述（由申请人提供）：终末期肾病（ESRD）患者占医疗保险受益人的一小部分，但占医疗保险费用的不成比例。他们再次住院的频率远远高于其他人，36%的患者在30天内再次住院。随着医疗保险和医疗补助服务中心（CMS）越来越关注降低所有医疗保险患者（包括透析患者）30天的再入院率，他们已经开始惩罚30天再入院的医院。尽管医生越来越多地被鼓励避免30天再住院，但尚不清楚透析患者（或医疗保险患者）是否可以预防30天再住院 患者作为一个整体），或者如果一些再住院治疗是潜在有益的。透析患者30天再入院的原因以前没有描述过，到目前为止，没有人试图了解30天再住院是否可以预防患者未来的不良事件。第一个目标主要是描述性的，将确定最常见的住院和再住院诊断对。它还将确定临床上 有联系的和没有联系的。第二个目标将采用30天再住院的最常见原因，并确定可能再住院的患者组和可能在3年内死亡的患者组，以便对患者B死亡率和再住院的可能性进行风险分层。第三个目标将采取高死亡可能性的患者，并通过观察他们是否有比预期更好的结果来确定可能从30天再入院中受益的患者群体。这项研究将帮助临床医生和政策制定者更好地了解30天再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减少“不适当的再住院”的政策，并将帮助医生了解何时考虑将再住院作为一种潜在的治疗方法。

 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.