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

来源：
https://reporter.nih.gov/project-details/8644879
关键词：
Acute myocardial infarction Caring Case Study Communities Congestive Heart Failure Data Goals Health Hospitalization Hospitals Inpatients Intervention Knowledge Leadership Marketing Medical Medicare Methods Minority Outcome Patients Performance Play Pneumonia Policies Prevention Provider Quality of Care Risk Role Site Surveys Time Variant Work administrative database effective intervention evidence based guidelines improved insight multilevel analysis novel payment programs public health relevance

Acute myocardial infarction Caring Case Study Communities Congestive Heart Failure Data Goals Health Hospitalization Hospitals Inpatients Intervention Knowledge Leadership Marketing Medical Medicare Methods Minority Outcome Patients Performance Play Pneumonia Policies Prevention Provider Quality of Care Risk Role Site Surveys Time Variant Work administrative database effective intervention evidence based guidelines improved insight multilevel analysis novel payment programs public health relevance

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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计划中住院治疗的三个最常见原因，并且每种原因都与30天的高30天有关。尽管在所有患者群体中的再入院都是常见的，但由于不太了解的原因，黑人患者比白人患者更有可能被重新入院。护理现场可能起着重要作用：对少数族裔的护理集中在少数少数族裔医院（MSHS）中，这些医院提供了较低的护理质量，并且结果较差，包括更高的再入院率。但是，即使在MSH中，也有很大的变化：在初步分析中，我们发现再入院率的三倍变化（例如，对于AMI，最佳四分位数中最佳的35.7％，而在最差的四分位数中为35.7％），一些MSHS可与最佳医院相提并论。《平价医疗法案》（ACA）通过要求医疗保险向具有高入院率的医院付款，并在对该提案的初步分析中，将减少再选项减少了，我们发现MSH在全国绩效最差的Quartile中的几乎三倍。如果这些医院无法改善，新政策可能会加剧现有的护理差异。但是，我们对为什么有些MSH的再入院率较低，而另一些人则落后，我们一无所知。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。我们建议检查关键的患者，医院和市场水平的因素，这些因素可以解释MSH之间的重大差异，并确定这些因素的存在是否解释了MSH和非MSH之间的性能差距。我们将使用案例研究来表征最高和最低风险调整后再入院率的MSH的再入院惯例。然后，我们将使用全国医院首席医疗官调查，以创建有关当前知识，优先事项和计划的首个国家图片再入院。最后，我们将使用管理数据库来检查这些因素解释MSH的再入院式变化的程度，我们确定的重要因素是否也解释了非MSH的变化，以及它们是否解释了非MSH和MSH之间的差异。了解MSH的再入院率的实质性变化将使我们能够确定与MSH相关的关键因素。这些数据将有助于决策者制定有效和新颖的干预措施，有助于MSH改善对所有患者的护理，从而减少再入院率的差异。