Understanding hospital readmission rates: patient, hospital and community effects

了解再入院率：患者、医院和社区的影响

• 批准号: 8671556
• 负责人: Leora Horwitz
• 金额: $ 101.21万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2019-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8671556
• 关键词: Understanding; hospital; readmission; rates; patient

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.

描述（由申请人提供）：再入院很常见，昂贵且通常不利于患者，但是患者，医院和社区因素与医院再入院率的关系尚不清楚。随着对减少医院再入院率的兴趣上升，这对 了解医院和社区对再入院率的影响的类型和程度，以便可以确定干预措施的最佳目标。在全国范围内，人们非常关注降低再入院率和增加护理的协调，这是由主要的联邦政策计划（例如医院参与网络，社区护理过渡计划和减少医院再入院计划）带头的。各个医院还从事当地努力，以最大程度地提高区域优势以减少再入院。调查团队以前已经开发了新的全条件30天的全面风险标准化医院计划外的再入院措施。该措施已得到国家质量论坛的认可，并将在2013年由Medicare公开报告。该措施可以用作经过验证的，风险标准的测定法，以比较医院的再入院率，同时考虑到医院诊断和病例混合的差异。此外，该度量是五个特定特异性子测量的组合，使我们能够按专业进行分层。我们将使用此测定法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，以及几个补充数据来源，我们的目标是：1）确定与再入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业队列（心血管疾病，心肺疾病，神经系统疾病，其他医学疾病和手术病）有关的每个医院和社区因素均相关； 3）表征2007年至2016年之间再入院率的趋势，确定改进与政策变化的关联，并对随着时间的变化最大和最小变化的医院进行深入的定性分析。该提案与几个AHRQ优先人群有关，包括低收入群体，少数群体，妇女，老年患者以及具有特殊医疗保健需求的个人，并将提供信息，以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。