Understanding hospital readmission rates: patient, hospital and community effects

描述(由申请人提供)：再入院很常见，费用很高，而且往往对患者有害，但患者、医院和社区因素与再住院率的关系尚不清楚。随着人们对减少再次住院的兴趣增加，至关重要的是 了解医院和社区对再住院率的影响的类型和程度，以便确定最佳干预目标。在全国范围内，在医院参与网络、社区护理过渡计划和医院再入院减少计划等主要联邦政策倡议的带头下，高度关注降低再住院率和加强护理协调。个别医院也参与当地的努力，最大限度地发挥地区优势，减少再入院人数。调查小组此前开发了一种新的全条件30天风险标准化医院范围内非计划再入院措施。这项措施已经得到了国家质量论坛的认可，并将在2013年由联邦医疗保险公开报告。该方法可作为一种有效的、风险标准化的分析方法，用于比较医院再住院率，同时考虑不同医院诊断和病例组合的差异。此外，该措施是由五个特定于专业的子措施组成的，允许我们按专业对结果进行分层。我们将使用这项测试来检查医院和社区对再住院率的影响，并研究重大政策变化的影响。具体地说，使用国家医疗保险管理索赔数据以及几个补充数据源，我们的目标是：1)确定与再住院率相关的医院和社区的特征；2)确定哪些医院和社区因素与五个临床专科队列(心血管疾病、心肺疾病、神经疾病、其他内科疾病和手术条件)中的每一个相关；以及3)描述2007至2016年间再次住院率的趋势，确定改进与政策变化的关联，并对随时间变化最大和最小的医院进行深入的定性分析。这项建议与AHRQ的几个重点人群有关，包括低收入群体、少数群体、妇女、老年患者和有特殊医疗需求的个人，并将提供信息，促进我们对医院重新入院的了解，使临床医生、医院和政策制定者能够改善对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.