私营部门再录取退伍军人卫生管理局医院的住院手术
Mary Vaughan Sarrazin1,2, Yubo Gao1,2, Carly A Jacobs3
1Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City.
JAMA network open
|December 26, 2024
概括
包括非VHA再入院影响医院绩效排名. 医院数量和复杂性较高的医院有所改善,而更多外部再入院的医院的指标有所恶化,突出了护理连续性的悖论.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善外科手术的质量
- 医疗保健绩效测量方法 医疗保健绩效测量方法
背景情况:
- 退伍军人卫生管理局 (VHA) 使用风险标准化的30天再接收率 (RSRR) 来衡量外科手术的性能.
- 目前的VHA指标往往不包括VHA设施以外发生的再接收,可能低估了真正的再接收负担.
研究的目的:
- 评估纳入非VHA再入院对VHA医院30天手术再入院绩效排名的影响.
主要方法:
- 一项回顾性队列研究分析了VHA和Medicare数据,这些数据来自于2013-2019年间接受手术的65岁以上的患者.
- 风险标准化再接收率是使用包括VHA-only和VHA加非VHA再接收的模型来计算的.
- 根据RSRRs,VHA医院被分为五分之一,并分析了在纳入非VHA再入院后五分之一排名的变化.
主要成果:
- 该研究包括104家VHA医院的108,265名患者;整体30天再入院率为14.0%.
- 在VHA以外的再接收人数比例差异很大 (中位数为20.9%).
- 包括非VHA再入院导致23.1%的医院提高了他们的绩效五分位数,22.1%的医院恶化.
结论:
- 在包括非VHA再入院后提高绩效排名的VHA医院通常具有更高的外科手术量,更高的复杂性和更少的外部再入院.
- 这些发现表明,改善护理连续性的努力可能会导致VHA表现指标较差.
- 准确评估VHA医院的表现需要全面跟踪所有原因,30天的再入院,无论设施.
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