Korea Journal of Hospital Management (한국병원경영학회지)

Korean Society of Hospital Management (한국병원경영학회)
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Does Process Quality of Inpatient Care Serve as a Guide to Reduce Potentially Preventable Readmission (PPR)?

의료서비스의 과정적 질과 잠재적으로 예방 가능한 재입원율과의 관계

  • Choi, Jae-Young (Healthcare Management Track, Department of Business Administration, Hallym University)
  • 최재영 (한림대학교 경영학과 의료경영트랙)
  • Received : 2018.02.06
  • Accepted : 2018.03.15
  • Published : 2018.03.31
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Abstract

Objective: The objective of this study is to examine the association between process quality of inpatient care and risk-adjusted, thirty-day potentially preventable hospital readmission (PPR) rates. Data Sources/Study Setting: This was an observational cross-sectional study of nonfederal acute-care hospitals located in two states California and Florida, discharging Medicare patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia January through December 31, 2007. Data were obtained from the Healthcare Cost and Utilization Project State Inpatient Database of the Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services Hospital Compare database, and the American Hospital Association Annual Survey of Hospitals. Study Design: The dependent variable of this study is condition-specific, risk-adjusted, thirty-day potentially preventable hospital readmission (PPR). 3M's PPR software was utilized to determine whether a readmission was potentially preventable. The independent variable of this study is hospital performance for process quality of inpatient care, measured by hospital adherence to recommended processes of care. We used multivariate hierarchical logistic models, clustered by hospitals, to examine the relationship between condition-specific, risk-adjusted, thirty-day PPR rates and process quality of inpatient care, after taking clinical and socio-demographic characteristics of patients and structural and operational characteristics of hospitals into account. Findings: Better performance on the process quality metrics was associated with better patient outcome (i.e., low thirty-day PPR rates) in pneumonia, but not generally in two cardiovascular conditions (i.e., heart failure and acute myocardial infarction). Practical Implication: Adherence to the process quality metrics currently in use by CMS is associated with risk-adjusted, thirty-day PPR rates for patients with pneumonia, but not with cardiovascular conditions. More evidence-based process quality metrics closely linked to 30-day PPR rates, particularly for cardiovascular conditions, need to be developed to serve as a guideline to reduce potentially preventable readmissions.

Purpose: 본 연구는 미국 캘리포니아와 플로리다에 위치한 의료기관을 대상으로 급성심근경색증, 심부전, 폐렴을 주진단으로 받은 메디케어 입원환자들에게 제공된 의료서비스의 과정적 질과 잠재적으로 예방이 가능한 30일 이내 위험 보정 재입원율과의 관계를 살펴보았다. Methods: 본 연구의 종속변수는 잠재적으로 예방이 가능한 30일 이내 위험 보정 질환별 재입원율이며 3M PPR 소프트웨어를 이용하여 재입원의 예방 가능 여부를 결정하였다. 미연방 의료 비용 및 이용 프로젝트 데이터베이스, 미국병원협회의 병원조사 자료, 미연방 보건복지부소속 메디케어 및 메디케이드 서비스 센터의 병원비교 자료를 이용하였다. 자료의 위계적 구조를 고려하여 다수준 로지스틱 회귀분석을 이용하여 분석하였다. Findings: 의료서비스의 과정적 품질과 퇴원 후 30일 이내 잠재적 예방 가능 위험도 보정 재입원율과의 관계는 질환별로 차이를 보였다. 폐렴의 경우 의료서비스의 과정적 질은 30일 이내 잠재적 예방 가능 보정 재입원율과 유의한 부(-)의 관계를 보였으나, 급성심근경색증과 심부전의 경우 대체로 유의한 관계를 관찰할 수 없었다. Practical Implications: 잠재적으로 예방 가능한 급성심근경색증, 심부전 재입원율을 줄이기 위해서는 의료기관에서 가이드라인으로 따를 수 있는 더욱 다양한 근거 중심의 과정적 질 지표의 개발에 대한 정부와 보건의료계의 노력이 필요하다.

Keywords

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