Hospital Readmission and Inpatient Medical Rehabilitation

描述(由申请人提供)：《患者保护和平价医疗法案》创建了一个“医院再入院减少计划”，以帮助急诊医院减少可避免的再住院。研究表明，大约20%的医疗保险患者在急性护理出院后30天内再次住院，其中大多数再次住院是可以预防的。审查再次住院的研究主要集中在从急性护理医院出院的患者。我们将研究接受住院康复治疗的大容量和高成本患者的再次住院率和原因，例如中风或髋部骨折患者。随着美国人口继续老龄化，这是一个研究不足的人群，对医疗资源和成本具有重要影响。我们的目标是确定六个最大的康复障碍群体中接受住院康复服务的人的再次入院率和相关因素，如下所示 由医疗保险和医疗补助服务中心(CMS)定义。我们提出以下具体目标：目的1.检查来自医疗保险和医疗补助服务中心以及医疗康复统一数据系统(UDSMR)的国家数据，以确定在美国接受住院医疗康复的六个最大残疾群体(中风、下肢骨折、下肢关节置换、虚弱、神经障碍和创伤性脑损伤)的再住院率(MedPAC，2011)。目的2.确定与六个功能障碍组再入院相关的患者特征(社会人口学和临床/功能)(见目标1)。我们将检查2006-2010年医疗保险和医疗补助服务中心的文件和医疗康复统一数据系统数据集的数据(约130万患者记录)。我们将使用探索性数据分析和描述性统计来确定六种康复障碍类别的再住院率。出院后90天内再次入院的个人和临床因素将被用来进行生存时间分析。我们的跨学科研究团队有20年使用大型国家数据集研究康复结果的经验。这些调查结果将解决《平价医疗法案》的优先事项，提供有助于开发未来预测模型的信息，并帮助记录医院问责和建立质量指标。 与公众健康相关：我们将研究高容量和高成本患者的再次入院率和原因，例如中风或髋部骨折并在康复机构接受急性后护理服务的患者。调查结果将提供有用的信息，有助于建立急性后护理的质量指标，并为再次住院的高危人群分配资源。结果还将通过确定降低医疗费用的战略，解决《患者保护和平价医疗法案》的优先事项。

DESCRIPTION (provided by applicant): The Patient Protection and Affordable Care Act creates a "hospital readmission reduction program" to help acute care hospitals decrease avoidable rehospitalizations. Research suggests approximately twenty percent of all Medicare patients are rehospitalized within 30 days of discharge from acute care and that the majority of these rehospitalizations are preventable. Research examining rehospitalization has focused primarily on patients discharged from acute care hospitals. We will examine rates and reasons for hospital readmission in high volume and high cost patients, such as those with stroke or hip fracture, who receive inpatient medical rehabilitation. This is an understudied population with important implications for health care resources and costs as the U.S. population continues to age. Our goal is to determine rates and factors associated with hospital readmissions in persons receiving inpatient rehabilitation services for the six largest rehabilitation impairment groups as defined by the Centers for Medicare and Medicaid Services (CMS). We propose the following Specific Aims: Aim 1. Examine national data from the Centers for Medicare and Medicaid Services and the Uniform Data System for Medical Rehabilitation (UDSMR) to determine rates of hospital readmission for the six largest impairment groups receiving inpatient medical rehabilitation in the U.S. (stroke, fracture of the lower extremity, joint replacement of the lowe extremity, debility, neurological disorders and traumatic brain injury) (MedPAC, 2011). Aim 2. Determine patient characteristics (sociodemographic and clinical/functional) associated with hospital readmission across the six impairment groups (see Aim 1). We will examine data from the Centers for Medicare and Medicaid Services files and the Uniform Data System for Medical Rehabilitation dataset for the years 2006 - 2010 (~ 1.3 million patient records). We will use exploratory data analysis and descriptive statistics to determine the rate of hospital readmission for the six rehabilitation impairment categories. Time-to-event survival analyses will be used to examine personal and clinical factors associated with hospital readmission during the first 90 days after discharge. Our interdisciplinary research team has twenty years of experience using large national datasets to study rehabilitation outcomes. The findings will address priorities of the Affordable Care Act, provide information useful in developing future predictive models, and assist in documenting hospital accountability and establishing quality indicators. PUBLIC HEALTH RELEVANCE: We will examine the rates and reasons for hospital readmission in high volume and high cost patients such as those who have a stroke or fracture their hip and receive post-acute care services in rehabilitation facilities. The findings will provde information useful in establishing quality indicators for post-acute care and the allocation of resources for persons at high risk for rehospitalization. The results will also address priorities f the Patient Protection and Affordable Care Act by identifying strategies to reduce health care costs.