新的研究发现再次入院手术后不受错误的护理

2015年2月3日

研究表明，绩效工资的政策措施应着眼于减少手术并发症，不再入院

与# 65279；芝加哥–；一项研究西北 医学注册； 和 美国外科医师学会今天发表在日本汽车制造商协会建议 这对医院的病人再入院手术后可能 效果不好，甚至起反作用，对于提高医院质量 美国护理。研究的作者，标题为“；底层 在美国医院的住院手术后相关的原因 美国，”；发现大多数外科入院是由于照顾不协调或管理不善 已知问题。相反，由于预期再入院手术 并发症，如伤口感染，发生后出院，并 一个病人是在不存在；医院停留时间超过百分之97。

“；There has been a growing focus on reducing hospital readmissions from policymakers in recent years, including readmissions after surgery，”； 说的主要作者卡尔Y. Bilimoria医师，医学博士，硕士，外科肿瘤学家和西北纪念医院质量的副主席，并 director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine. “；But before this study, we didn’t really understand the underlying reasons why patients were being readmitted to hospitals following surgery.”

目前，医院&rsquo；的所有计划外的病人入院率，包括外科手术的患者，是公开的医疗保险和医疗补助服务中心（CMS）的报告。此外，医院&rsquo；CMS的报销如果CMS确定医院内病人'后30天再住院减少了太多；对于某些关心的流量，包括髋关节和膝关节置换手术。这一政策，称为入院还原程序，于2012年10月1日生效的平价医疗法案（ACA），但这部分最初只专注于心脏病住院，心脏衰竭和肺炎。该研究的作者注意其他手术类型将被纳入CMS &rsquo；在不久的将来再次削减计划。

To better understand the reasons behind postoperative readmissions, researchers collected data from the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) from 346 U.S. hospitals for the full year of 2012. These data specifically included the underlying reason for why the readmission occurred based on the medical record, discussions with treating doctors, and the patients themselves –； data that are not available elsewhere. Six different surgical procedure types were reviewed based on their clinical and CMS policy relevancy, resulting in a total of 498,875 separate patient cases being analyzed for the study. The six procedures reviewed were:

• 减肥手术，
• 结肠或直肠切除术，
• 子宫切除术，
• 全髋关节或膝关节置换，
• 腹疝修补术
• 下肢血管旁路术。

研究人员发现，病人百分之5.7例，非计划再入院。那些非计划再入院，只有百分之2.3的患者再次入院，在医院由于其初始期间发生的并发症。

“；These results clearly demonstrates that the vast majority of complications that cause readmissions are not due to a lack of coordination or complications that occurred during the initial hospitalizations，”； said Bilimoria, who is also a member of the Robert H. Lurie Comprehensive Cancer Center. “；These complications were new and occurred after the patients were discharged and were recovering at home.”

The study also found that the most common cause for unplanned readmissions was surgical-site infections at 19.5 percent, followed by delayed return of bowel function with an overall rate of 10.3 percent. The study’s authors go on to point out that while these two postsurgical complications are the top two causes for readmissions, compliance with available quality measures to reduce these complications is often already high among hospitals in America and implementing, “；policies requiring reductions in readmissions without understanding how to impact improvement could be counterproductive.”

“；Many of the issues that were identified can help hospitals better focus their efforts to continue to reduce potential readmissions. Our results also highlighted that many of the complications involved in readmissions, such as surgical-site infections, are already well-know and part of other CMS pay-for-performance programs, which means hospitals are effectively being penalized twice for the same complications，”； added Bilimoria.

额外的并发症导致住院，在分析确定包括脱水、营养缺乏、出血，静脉血凝块和假体或移植的问题，但这些变化很大，取决于程序。不过，作者指出，这些并发症，如脱水，是值得解决的可能是有机会通过更好的沟通与病人，病人教育，创新护理重新设计，以减少其发生。

“；Underlying Factors Associated with Hospital Readmission Following Surgery in the United States，”；目前可在日本汽车制造商协会’s网站 and will appear in the 2015年2月3日 print edition of the journal.



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