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Using Veterans Affairs Corporate Data Warehouse to identify 30-day hospital readmissions

机译：使用退伍军人事务公司数据仓库识别30天医院入院

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摘要

Hospital readmission is a key metric of hospital quality, such as for comparing Veterans Affairs (VA) hospitals to private sector hospitals. To calculate readmission rates, one must first identify individual hospitalizations. However, in the VA Corporate Data Warehouse (CDW), data are organized by "bedded stays," that is, any stay in a healthcare facility where a patient is provided a bed, not hospitalizations. Thus, CDW data poses several challenges to identifying hospitalizations including: (1) bedded stays include both non-acute inpatient stays (i.e. nursing home, mental health) and acute inpatient hospital care; (2) transfers between VA facilities appear as separate bedded stays; and (3) VA care may also be fragmented by non-VA care. Thus, we sought to develop a rigorous method to identify acute hospitalizations using the VA CDW. We examined all VA bedded stays with an admission date in 2009. Non-acute portions of a stay were dropped. VA to VA transfers were merged when consecutive discharge and admission dates were within one calendar day. Finally, hospitalizations that occurred in a non-VA facility were merged. The 30-day readmission rate was calculated at each step of the algorithm to demonstrate the impact. The total number of VA medical hospitalizations in 2009 with live discharges was 505,861. The 30-day readmission rate after adjusting for VA to VA transfers and incorporating non-VA care was 18.3% (95% confidence interval (CI): 18.2, 18.4%).
机译：医院入院是医院质量的关键指标，例如将退伍军人事务（VA）医院与私营部门医院进行比较。要计算入院率，必须首先识别个人住院治疗。但是，在VA公司数据仓库（CDW）中，数据由“Bedded Stays”组织，也就是说，任何住在医疗保健机构中，患者提供床，而不是住院。因此，CDW数据对识别住院治疗的若干挑战包括：（1）卧房住宿包括非急性住院住宿（即护理家庭，心理健康）和急性住院医院护理; （2）VA设施之间的转移显示为单独的床位; （3）VA护理也可通过非VA护理分段。因此，我们寻求使用VA CDW来识别急性住院的严格方法。我们在2009年审查了所有VA床位的入住日期。留下的非急性部分。当连续卸货和录取日期在一个日历日内，va到转账被合并。最后，合并了非VA设施中发生的住院治疗。在算法的每个步骤中计算了30天的阅约率，以证明影响。 2009年与现场放电的VA医疗住院总数为505,861。调整VA转移后30天的阅约率为18.3％（95％置信区间（CI）：18.2,18.4％）。

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