在包括观察停留在内的替代再接收措施下医院的表现
Amber K Sabbatini1,2, Canada Parrish1,2, Joshua M Liao3,4
1Department of Emergency Medicine, University of Washington School of Medicine.
Medical care
|September 15, 2023
概括
包括在医院再接收措施中的观察停留时间显著改变了绩效指标. 这影响了以价值为基础的计划,特别是对于安全网医院和那些观察率高的医院.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善医疗保健质量 改善医疗保健质量
- 医院绩效测量方法 医院绩效测量方法
背景情况:
- 医院再入院率是基于价值的医疗保健的关键绩效指标.
- 目前的措施往往不包括观察停留,可能会误导医院的表现.
- 了解观察逗留的影响对于准确的质量评估至关重要.
研究的目的:
- 评估包括观察停留时间如何影响30天再接收措施的医院绩效.
- 为了确定医院的特点与绩效变化相关,当观察停留被纳入.
主要方法:
- 追溯分析2017年医疗保险服务费入院和观察期间的情况.
- 三种再接收措施的比较:全医院再接收 (HWR),扩展的HWR (包括观察停留时间) 和全住院再接收 (AHR).
- 多变量后勤回归用于识别与性能转移相关的因素.
主要成果:
- 观察停留时间差异很大 (0%至41.7%的住院病例).
- 包括观察停留时间导致大约14.9%的医院改变绩效分类 (高绩效到低绩效或反之).
- 安全网医院和那些使用观察更高的医院在包括观察逗留时表现明显差.
结论:
- 完全纳入观察停留实质性地改变了医院在基于价值的计划中的表现.
- 这一变化不成比例地影响了安全网医院和高度使用观察住院的医院.
- 为了公平而准确的医院绩效评估,需要完善再接收措施.
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