Early Examination of Hospital‐Level Performance on Unplanned, Potentially Avoidable Hospital Visits After Chemotherapy, 2018–2022
分析了2018-2022年美国医院化疗后可避免的急诊和住院率变化，发现全国率下降，但多数医院绩效与全国平均无显著差异，且下降部分可能源于统计回归效应。
OBJECTIVE: To assess changes in publicly reported, potentially avoidable hospital visits after chemotherapy since the introduction of a Medicare quality measure. STUDY SETTING AND DESIGN: Retrospective analysis of avoidable emergency department (ED) and inpatient admission (ADM) rates after chemotherapy between 2018 and 2022, across absolute visit rates and relative hospital performance ("better than", "no different than", "worse than" the national rate). We stratified hospitals into quartiles of visit rates in 2018 and used this to model the change in visit rates from 2018 to 2022 with generalized linear regression. DATA SOURCES AND ANALYTIC SAMPLE: A longitudinal cohort of hospitals from the Medicare Outpatient Quality Reporting Program. PRINCIPAL FINDINGS: We analyzed 1179 hospitals (94.3% non-profit, 22.9% teaching). National avoidable ED visit rates were 6.0% in 2018, 5.4% in 2022; ADM rates were 12.5% in 2018, 10.3% in 2022. Nearly all hospitals were deemed to have performed "no different" than the national rate each year in ED (≥ 95.3%) and ADM (≥ 91.1%). In adjusted analyses, visit rates for hospitals in the lowest 2018 visit rate quartiles declined the least by 2022 (ED: -0.44% 95% CI: -0.58 to -2.94; ADM: -0.91%, 95% CI: -1.14 to -0.69), and declined the most for hospitals in the highest 2018 quartiles (ED: -1.72%, 95% CI: -1.85 to -7.73; ADM: -3.03%, 95% CI: -3.27 to -2.81). We estimated that the tendency for extreme baseline values to approach the average over time accounted for up to one-tenth of the decline among the worst-performing 2018 quartiles (ED: 10.6% of rate change, 95% CI: 9.8 to 11.5; ADM: 9.0%, 95% CI: 8.2 to 9.8). CONCLUSION: Hospitals reduced their potentially avoidable hospital visit rates, though Medicare deemed that nearly all hospitals performed "no different" than the national average each year. It remains unclear if the reductions were driven by this quality measure.