Comparative Effectiveness Research on Hospital Readmissions for COPD

慢性阻塞性肺病再入院的比较效果研究

基本信息

批准号：
9768958
负责人：
CARLOS A. CAMARGO
金额：
$ 24.92万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-30 至 2020-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9768958
关键词：
Comparative Effectiveness Research Hospital Readmissions

项目摘要

DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death in the United States, surpassing stroke in 2008. The natural history of COPD is punctuated by recurrent acute exacerbations of COPD, which are associated with significant morbidity and healthcare costs. In 2010, there were about 699,000 COPD hospitalizations in the US, costing the nation $13 billion dollars in hospital bills. Furthermore, 1 in 5 hospitalizations is followed by a readmission within 30 days of discharge. To address this high-readmission issue, the Centers for Medicare and Medicaid Services (CMS) is proposing to add 30-day all-cause mortality and readmission rates for COPD as new publicly-reported quality measures. In addition, under the Affordable Care Act, CMS has been authorized to financially penalize hospitals for excessive readmissions for an initial set of three conditions (acute myocardial infarction, heart failure, and pneumonia) since October 1, 2012. Beginning in fiscal year 2015, the list will expand to include COPD. However, there is a dearth of research on COPD readmission, such as lack of a validated risk-adjustment model and scant information on best treatment strategies to reduce COPD readmissions. We propose to compile and analyze national, longitudinal data from four sources (the Healthcare Cost and Utilization Project [HCUP], the Medicare Claims/Part D drug data, the Medicare Current Beneficiary Survey [MCBS], and the National Health and Nutrition Examination Survey [NHANES]-Medicare linked data) to address these knowledge gaps. The Specific Aims are: (1) To examine national trends in 30-day readmission rates (all-cause and cause-specific) after hospitalization for COPD during 2006-2012, both overall and by race/ethnicity, US regions, number of comorbid conditions, and AHRQ- defined priority populations (e.g., women and the elderly); (2) To develop and validate three risk-adjustment models for 30-day all-cause COPD readmission: models based on administrative claims alone (Medicare), survey-enhanced claims (MCBS), and clinically-enriched claims (NHANES-Medicare); (3) To compare the effectiveness of initiation of guideline-recommended interventions in reducing all-cause and COPD-related rehospitalizations at 30 days and 1 year. The interventions will include 5 broad strategies encompassing 8 comparisons: smoking cessation (e.g., varenicline vs. bupropion), vaccines (e.g., influenza and pneumococcal), bronchodilators/combination therapies, pulmonary rehabilitation, and follow-up with a primary care provider. The proposed study is highly significant because it addresses both clinical and methodological aspects of CER on COPD readmission, an understudied but very important topic. The study will generate novel results including epidemiologic analysis to identify subpopulations at higher risk for readmissions, three new risk-adjustment/prediction models, and information on best treatment options in reducing COPD readmissions. Accordingly, we expect that the results will help reduce costly readmissions and have important implications for patients, family members, clinicians, health insurers, hospital administrators, and policymakers.

描述（由申请人提供）：慢性阻塞性肺疾病 (COPD) 目前是美国第三大死亡原因，在 2008 年超过中风。COPD 的自然病程中不时出现慢性阻塞性肺病的反复急性加重，这与慢性阻塞性肺病 (COPD) 的复发性急性加重有关。 2010 年，美国约有 699,000 名慢性阻塞性肺病患者住院治疗，造成国家损失 130 亿美元。此外，五分之一的住院患者会在出院后 30 天内再次入院。为了解决这一高再入院问题，医疗保险和医疗补助服务中心 (CMS) 建议增加 30 天全因死亡率。此外，根据《平价医疗法案》，CMS 已被授权对最初三项过度再入院的医院进行经济处罚。自 2012 年 10 月 1 日起，该名单将扩大到包括慢性阻塞性肺病 (COPD)。然而，缺乏针对慢性阻塞性肺病 (COPD) 再入院的研究，例如缺乏经过验证的研究。风险调整模型和减少慢性阻塞性肺病再入院的最佳治疗策略的信息很少。我们建议汇编和分析来自四个来源（医疗保健成本和利用项目）的国家纵向数据。 [HCUP]、医疗保险索赔/D 部分药物数据、医疗保险当前受益人调查 [MCBS] 以及国家健康和营养检查调查 [NHANES]-医疗保险相关数据），以解决这些知识差距。具体目标是：（ 1) 研究 2006 年至 2012 年期间因慢性阻塞性肺病 (COPD) 住院后 30 天再入院率（全因和特定原因）的全国趋势，包括整体情况和按种族/族裔划分的情况，美国各地区、人数(2) 开发和验证 30 天全因 COPD 再入院的三种风险调整模型：仅基于行政索赔的模型（医疗保险）、调查强化索赔 (MCBS) 和临床丰富索赔 (NHANES-Medicare) (3) 比较启动指南推荐的干预措施在减少风险方面的有效性；干预措施包括 30 天和 1 年的全因和慢性阻塞性肺病相关的再住院，其中包括 8 项比较：戒烟（例如伐尼克兰与安非他酮）、疫苗（例如流感和肺炎球菌）、支气管扩张剂/联合疗法。、肺康复以及初级保健提供者的随访这项拟议的研究非常重要，因为它涉及临床和方法学方面。 CER 对 COPD 再入院的影响，这是一个尚未充分研究但非常重要的课题，该研究将产生新的结果，包括识别再入院风险较高的亚群的流行病学分析、三种新的风险调整/预测模型以及减少 COPD 再入院的最佳治疗方案的信息。因此，我们预计研究结果将有助于减少昂贵的再入院费用，并对患者、家庭成员、支持者、健康保险公司、医院管理人员和政策制定者产生重要影响。