Relationship Between Hospital Readmission and Mortality Rates for Patients Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia

被引：304

作者：

Krumholz, Harlan M. ^{[1
,2
,4
,5
]}

Lin, Zhenqiu ^{[4
]}

Keenan, Patricia S. ^{[5
]}

Chen, Jersey ^{[10
]}

Ross, Joseph S. ^{[2
,3
,4
]}

Drye, Elizabeth E. ^{[1
,4
]}

Bernheim, Susannah M. ^{[3
,4
]}

Wang, Yun ^{[4
,6
]}

Bradley, Elizabeth H. ^{[5
]}

Han, Lein F. ^{[8
,9
]}

Normand, Sharon-Lise T. ^{[6
,7
]}

机构：

[1] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA

[2] Yale Univ, Sch Med, Dept Internal Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06510 USA

[3] Yale Univ, Sch Med, Dept Internal Med, Gen Internal Med Sect, New Haven, CT 06510 USA

[4] Yale New Haven Hosp, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA

[5] Yale Univ, Sch Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06510 USA

[6] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA

[7] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA

[8] Ctr Medicare Serv, Baltimore, MD USA

[9] Ctr Medicaid Serv, Baltimore, MD USA

[10] Yale Univ, Dept Med, Sect Cardiovasc Med, New Haven, CT 06510 USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2013年 / 309卷 / 06期

基金：

美国医疗保健研究与质量局;

关键词：

PERFORMANCE; CARE; URBAN;

D O I：

10.1001/jama.2013.333

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Importance The Centers for Medicare & Medicaid Services publicly reports hospital 30-day, all-cause, risk-standardized mortality rates (RSMRs) and 30-day, all-cause, risk-standardized readmission rates (RSRRs) for acute myocardial infarction, heart failure, and pneumonia. The evaluation of hospital performance as measured by RSMRs and RSRRs has not been well characterized. Objective To determine the relationship between hospital RSMRs and RSRRs overall and within subgroups defined by hospital characteristics. Design, Setting, and Participants We studied Medicare fee-for-service beneficiaries discharged with acute myocardial infarction, heart failure, or pneumonia between July 1, 2005, and June 30, 2008 (4506 hospitals for acute myocardial infarction, 4767 hospitals for heart failure, and 4811 hospitals for pneumonia). We quantified the correlation between hospital RSMRs and RSRRs using weighted linear correlation; evaluated correlations in groups defined by hospital characteristics; and determined the proportion of hospitals with better and worse performance on both measures. Main Outcome Measures Hospital 30-day RSMRs and RSRRs. Results Mean RSMRs and RSRRs, respectively, were 16.60% and 19.94% for acute myocardial infarction, 11.17% and 24.56% for heart failure, and 11.64% and 18.22% for pneumonia. The correlations between RSMRs and RSRRs were 0.03 (95% CI, -0.002 to 0.06) for acute myocardial infarction, -0.17 (95% CI, -0.20 to -0.14) for heart failure, and 0.002 (95% CI, -0.03 to 0.03) for pneumonia. The results were similar for subgroups defined by hospital characteristics. Although there was a significant negative linear relationship between RSMRs and RSRRs for heart failure, the shared variance between them was only 2.9% (r(2)=0.029), with the correlation most prominent for hospitals with RSMR <11%. Conclusion and Relevance Risk-standardized mortality rates and readmission rates were not associated for patients admitted with an acute myocardial infarction or pneumonia and were only weakly associated, within a certain range, for patients admitted with heart failure. JAMA. 2013;309(6):587-593 www.jama.com

引用

页码：587 / 593

页数：7

共 23 条

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