Identifying Ways to Reduce Readmissions Among Minority-Serving U.S. Hospitals

确定减少为少数族裔服务的美国医院再入院率的方法

基本信息

批准号：
8644879
负责人：
ASHISH K JHA
金额：
$ 39.49万
依托单位：
HARVARD SCHOOL OF PUBLIC HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2016-03-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia are three of the most common reasons for hospitalization in the Medicare program, and each is associated with high 30-day readmission rates. Although readmissions are common across all patient groups, black patients are more likely than white patients to be readmitted for reasons that are not well understood. The site of care likely plays an important role: care for minorities is concentrated among a small number of minority-serving hospitals (MSHs), which provide a lower quality of care and have worse outcomes, including higher readmission rates. However, even among MSHs, there are large variations: in preliminary analyses, we found three-fold variations in readmission rates (e.g. for AMI, 12.2% in the best versus 35.7% in the worst quartile) with some MSHs achieving results comparable to the best hospitals nationally. The Affordable Care Act (ACA) has made reducing readmissions a priority by requiring that Medicare lower payments to hospitals with high readmission rates and in preliminary analyses for this proposal, we found that MSHs have nearly three times greater odds of being in the worst quartile of performance nationally. If these hospitals fail to improve, the new policy is likely to worsen existing disparities in care. However, we know little about why some MSHs have low readmission rates while others lag behind. Helping MSHs reduce readmissions is critically important, but we lack the empirical data to make evidence-based recommendations. We propose to examine key patient-, hospital-, and market-level factors that explain the large variations in readmission among MSHs, and determine if the presence of these factors explains gaps in performance between MSHs and non-MSHs. We will use case studies to characterize readmission prevention practices at MSHs with the highest and lowest risk-adjusted readmission rates. We will then use a national survey of hospital Chief Medical Officers to create the first national picture of current knowledge, priorities, and programs around readmissions. Finally, we will use administrative databases to examine the degree to which these factors explain variations in readmissions among MSHs, whether the important factors we identify also explain variation at non-MSHs, and whether they explain disparities between non-MSHs and MSHs. Understanding the substantial variations in readmission rates among MSHs will allow us to identify key factors that are actionable and relevant to MSHs. These data will help policymakers craft effective and novel interventions help MSHs improve care for all their patients, thus reducing disparities in readmissions.

描述（由申请人提供）：急性心肌梗塞 (AMI)、充血性心力衰竭 (CHF) 和肺炎是 Medicare 计划中最常见的三种住院原因，每种原因都与较高的 30 天再入院率相关。尽管再入院在所有患者群体中都很常见，但黑人患者比白人患者更有可能因尚不清楚的原因而再次入院。护理地点可能发挥着重要作用：对少数族裔的护理集中在少数为少数族裔服务的医院（MSH）中，这些医院提供的护理质量较低，结果较差，包括较高的再入院率。然而，即使在 MSH 之间，也存在很大差异：在初步分析中，我们发现再入院率有三倍的差异（例如，对于 AMI，最好的四分位数为 12.2%，最差的四分位数为 35.7%），一些 MSH 取得的结果与其他 MSH 相当。全国最好的医院。《平价医疗法案》(ACA) 将减少再入院列为优先事项，要求医疗保险降低对再入院率高的医院的付款，在对该提案的初步分析中，我们发现 MSH 处于最差四分位的可能性近三倍全国表现。如果这些医院无法改善，新政策可能会加剧现有的护理差距。然而，我们对为什么一些 MSH 的再入院率较低而另一些则落后的原因知之甚少。帮助 MSH 减少再入院至关重要，但我们缺乏经验数据来提出基于证据的建议。我们建议检查患者、医院和市场层面的关键因素，这些因素可以解释 MSH 之间再入院的巨大差异，并确定这些因素的存在是否可以解释 MSH 和非 MSH 之间的绩效差距。我们将利用案例研究来描述风险调整再入院率最高和最低的 MSH 的再入院预防实践。然后，我们将利用对医院首席医疗官的全国调查来创建第一个关于当前知识、优先事项和项目的全国图片重新入院。最后，我们将使用管理数据库来检查这些因素在多大程度上解释了 MSH 之间的再入院差异，我们确定的重要因素是否也解释了非 MSH 的差异，以及它们是否解释了非 MSH 和 MSH 之间的差异。了解 MSH 之间再入院率的巨大差异将使我们能够确定与 MSH 相关且可采取行动的关键因素。这些数据将帮助政策制定者制定有效且新颖的干预措施，帮助 MSH 改善对所有患者的护理，从而减少再入院的差异。