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Hospital Readmission Reduction Programs in Upstate New York: Correlates, Best Practices and Nursing Contributions

机译：纽约州北部的医院再入院减少计划：相关性，最佳实践和护理贡献

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摘要

Background: Patients with heart failure and pneumonia continue to have poor health as evidenced by high admission rates. While New York State exceeds one billion dollars for heart failure and pneumonia, it also ranks 50th, the worst in the nation, for poor readmission rates. Additionally, quality of care is under more scrutiny because the Affordable Care Act penalizes hospitals with excessive readmission rates by lowering reimbursement to hospitals treating Medicare recipients. Reduced hospital reimbursements threaten the financial stability of hospitals and would impact proper nurse staffing a major factor in patient health and safety outcomes. Many hospitals have initiated programs but no studies have compared these various programs in order to determine which are more effective at lowering readmissions and reimbursement penalties.;Objectives: The study's purpose was to identify hospital programs and related factors that contributed significantly to reductions in hospital readmission rates and payment penalties for hospitals in upstate New York.;Methods: Using an ex post facto design within the framework of the ecological and synergy models, community and organizational characteristics of hospital systems and educational levels of nursing involvement in hospital programs were analyzed and coded. Independent t-tests, ANOVA, and Pearson's Correlation tests were conducted.;Results: Organizational programs that reduce various hospital readmission rates and reimbursement penalties for hospitals in upstate New York are (a) certified home health agencies; (b) telehealth; (c) house calls; (d) APNs on interdisciplinary discharge teams; and (e) increasing the number of hospital readmission reduction programs utilized. Community characteristics that improve outcomes include (a) hospitals located in counties with a lower health ranking score; (b) house calls in primary care shortage areas; (c) utilizing a greater number of hospital readmission reduction programs in primary care shortage areas; and (d) critical access hospitals.;Conclusions: Regulatory and financial support should be provided for the following organizational programs: certified home health agencies, telehealth, house calls, and APNs. On a community level, the allocation of resources for improving county health ranking needs to be a priority.
机译：背景：心力衰竭和肺炎患者的健康状况仍然很差，入院率高证明了这一点。尽管纽约州因心力衰竭和肺炎而花费超过10亿美元，但因再入院率低而排名第50位，在全美排名最差。此外，医疗质量受到更严格的审查，因为《平价医疗法案》通过降低对治疗Medicare接受者的医院的报销，对住院率过高的医院进行了处罚。减少的医院报销会威胁到医院的财务稳定性，并会影响护士的适当配备，这是影响患者健康和安全结果的主要因素。许多医院已经启动了计划，但没有研究进行比较以确定哪种计划在降低再住院和报销方面更有效。目的：该研究的目的是确定对减少住院人数产生重大影响的医院计划和相关因素方法：在生态和协同模型的框架内使用事后设计，分析和编码医院系统的社区和组织特征，以及对医院计划中护理人员的教育程度进行编码。结果：降低纽约州北部地区医院各种住院率和报销罚款的组织方案是（a）认证的家庭健康机构； （b）远程保健； （c）上门拜访； （d）跨学科出勤小组的APN； （e）增加利用医院减少再入院计划的数量。可以改善结果的社区特征包括：（a）位于健康评分较低的县级医院； （b）在初级保健短缺地区打电话。 （c）在基层医疗短缺地区采用更多的减少医院再入院方案；结论：应当为以下组织计划提供监管和财务支持：经认证的家庭保健机构，远程医疗，上门拜访和APN。在社区一级，分配资源以改善县卫生排名必须成为优先事项。

著录项

  • 作者

    Summers, Michele L.;

  • 作者单位

    State University of New York at Binghamton.;

  • 授予单位 State University of New York at Binghamton.;
  • 学科 Nursing.;Public health.;Health care management.
  • 学位 Ph.D.
  • 年度 2018
  • 页码 185 p.
  • 总页数 185
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 水产、渔业;
  • 关键词

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