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首页> 外文期刊>Medical care >Comparing 2 methods of assessing 30-day readmissions: What is the impact on hospital profiling in the veterans health administration?
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Comparing 2 methods of assessing 30-day readmissions: What is the impact on hospital profiling in the veterans health administration?

机译：比较两种评估30天再入院的方法：退伍军人卫生管理局对医院概况的影响是什么？

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BACKGROUND:: The Centers for Medicare and Medicaid Services' (CMS) all-cause readmission measure and the 3M Health Information System Division Potentially Preventable Readmissions (PPR) measure are both used for public reporting. These 2 methods have not been directly compared in terms of how they identify high-performing and low-performing hospitals. OBJECTIVES:: To examine how consistently the CMS and PPR methods identify performance outliers, and explore how the PPR preventability component impacts hospital readmission rates, public reporting on CMS' Hospital Compare website, and pay-for-performance under CMS' Hospital Readmission Reduction Program for 3 conditions (acute myocardial infarction, heart failure, and pneumonia). METHODS:: We applied the CMS all-cause model and the PPR software to VA administrative data to calculate 30-day observed FY08-10 VA hospital readmission rates and hospital profiles. We then tested the effect of preventability on hospital readmission rates and outlier identification for reporting and pay-for-performance by replacing the dependent variable in the CMS all-cause model (Yes/No readmission) with the dichotomous PPR outcome (Yes/No preventable readmission). RESULTS:: The CMS and PPR methods had moderate correlations in readmission rates for each condition. After controlling for all methodological differences but preventability, correlations increased to >90%. The assessment of preventability yielded different outlier results for public reporting in 7% of hospitals; for 30% of hospitals there would be an impact on Hospital Readmission Reduction Program reimbursement rates. CONCLUSIONS:: Despite uncertainty over which readmission measure is superior in evaluating hospital performance, we confirmed that there are differences in CMS-generated and PPR-generated hospital profiles for reporting and pay-for-performance, because of methodological differences and the PPR's preventability component.
机译：背景：：医疗保险和医疗补助服务中心（CMS）的全因再入院措施和3M健康信息系统部门的潜在可预防再入院（PPR）措施均用于公开报告。这两种方法在确定高性能医院和低性能医院方面没有直接比较。目标：：研究CMS和PPR方法如何一致地识别绩效异常，并探讨PPR预防性因素如何影响医院再入院率，CMS医院比较网站上的公开报告以及CMS医院再入院减少计划下的绩效绩效适用于3种情况（急性心肌梗塞，心力衰竭和肺炎）。方法：我们将CMS全因模型和PPR软件应用于VA行政数据，以计算30天FY08-10 VA医院再入院率和医院概况。然后，我们通过将二分类PPR结果（是/否可预防）替换CMS全因模型（是/否再入院）中的因变量，来测试可预防性对医院再入院率和离群识别的影响，以报告和按绩效进行支付。重新入场）。结果：： CMS和PPR方法在每种情况下的再入院率均具有中等相关性。在控制了所有方法上的差异（可预防性）之后，相关性增加到> 90％。对可预防性的评估产生了不同的异常结果，供7％的医院公开报告。对于30％的医院，这将对减少医院再入院计划的报销率产生影响。结论：：尽管尚不确定哪种再入院措施在评估医院绩效方面具有优势，但我们确认，由于方法和PPR的可预防性因素不同，CMS生成和PPR生成的医院档案在报告和按绩效付费方面存在差异。

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