Impact of socioeconomic status measures on hospital profiling in New York City.

Autor:	Blum AB; From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.). abb@evergreenmd.org., Egorova NN; From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)., Sosunov EA; From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)., Gelijns AC; From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)., DuPree E; From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)., Moskowitz AJ; From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)., Federman AD; From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)., Ascheim DD; From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)., Keyhani S; From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2014 May; Vol. 7 (3), pp. 391-7. Date of Electronic Publication: 2014 May 13.
DOI:	10.1161/CIRCOUTCOMES.113.000520
Abstrakt:	Background: Current 30-day readmission models used by the Center for Medicare and Medicaid Services for the purpose of hospital-level comparisons lack measures of socioeconomic status (SES). We examined whether the inclusion of an SES measure in 30-day congestive heart failure readmission models changed hospital risk-standardized readmission rates in New York City (NYC) hospitals. Methods and Results: Using a Centers for Medicare & Medicaid Services (CMS)-like model, we estimated 30-day hospital-level risk-standardized readmission rates by adjusting for age, sex, and comorbid conditions. Next, we examined how hospital risk-standardized readmission rates changed relative to the NYC mean with inclusion of the Agency for Healthcare Research and Quality (AHRQ)-validated SES index score. In a secondary analysis, we examined whether inclusion of the AHRQ SES index score in 30-day readmission models disproportionately impacted the risk-standardized readmission rates of minority-serving hospitals. Higher AHRQ SES scores, indicators of higher SES, were associated with lower odds (0.99) of 30-day readmission (P<0.019). The addition of the AHRQ SES index did not change the model's C statistic (0.63). After adjustment for the AHRQ SES index, 1 hospital changed status from worse than the NYC average to no different than the NYC average. After adjustment for the AHRQ SES index, 1 NYC minority-serving hospital was reclassified from worse to no different than average. Conclusions: Although patients with higher SES were less likely to be admitted, the impact of SES on readmission was small. In NYC, inclusion of the AHRQ SES score in a CMS-based model did not impact hospital-level profiling based on 30-day readmission. (© 2014 American Heart Association, Inc.)
Databáze:	MEDLINE
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