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Interhospital Variability in Cardiac Rehabilitation Use after Cardiac Surgery among Medicare Beneficiaries

Journal of Thoracic and Cardiovascular Surgery(2024)SCI 1区SCI 2区

Oakland University William Beaumont School of Medicine | Department of Cardiac Surgery | Department of Surgery | Department of Health Management and Policy | Division of Cardiovascular Medicine

Cited 0|Views23
Abstract
ObjectiveDespite guideline recommendation, cardiac rehabilitation (CR) following cardiac surgery remains underutilized, and the extent of interhospital variability is not well understood. This study evaluated determinants of interhospital variability in CR use and outcomes.MethodsThis retrospective cohort study included 166,809 Medicare beneficiaries undergoing cardiac surgery who were discharged alive between 07/01/2016 and 12/31/2018. CR participation was identified in outpatient facility claims within a year of discharge. Hospital-level CR rates were tabulated, and multilevel models evaluated the extent to which patient, organizational, and regional factors accounted for interhospital variability. Adjusted 1-year mortality and readmission rates were also calculated for each hospital quartile of CR use.ResultsOverall, 90,171 (54.1%) participated in at least one CR session within a year of discharge. Interhospital CR rates ranged from 0.0% to 96.8%. Hospital factors that predicted CR use included non-teaching status and lower hospital volume. Before adjusting for patient, organizational, and regional factors, 19.3% of interhospital variability was attributable to the admitting hospital. After accounting for covariates, 12.3% of variation was attributable to the admitting hospital. Patient (0.5%), structural (2.8%), and regional (3.7%) factors accounted for the remaining explained variation. Hospitals in the lowest quartile of CR use had higher adjusted 1-year mortality rates (Q1 = 6.7%, Q4 = 5.2%, p < 0.001) and readmission rates (Q1 = 37.6%, Q4 = 33.9%, p<0.001).ConclusionIdentifying best practices among high CR use facilities and barriers to access in low CR use hospitals may reduce interhospital variability in CR use and advance national improvement efforts.
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Key words
Cardiac rehabilitation,cardiac surgery,CABG,SAVR
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要点】:本研究探讨了美国医疗保险受益者在心脏手术后心脏康复(CR)使用的医院间差异及其影响因素,发现医院因素对CR使用有显著影响,且CR使用率较低的医院有更高的死亡率和再入院率。

方法】:采用回顾性队列研究方法,对2016年7月1日至2018年12月31日间 alive 出院的心脏手术患者进行数据分析,通过医院级别的CR率以及多水平模型评估患者、组织机构和地区因素对医院间CR使用差异的影响。

实验】:研究纳入了166,809名Medicare受益者,发现54.1%的患者在出院后一年内至少参与了一次CR。医院间CR使用率从0.0%至96.8%不等。通过调整患者、组织机构和地区因素后,医院因素解释了12.3%的医院间变异。CR使用率最低的四分位数医院的一年调整后死亡率(Q1 = 6.7%,Q4 = 5.2%)和再入院率(Q1 = 37.6%,Q4 = 33.9%)均显著高于CR使用率最高的医院。使用的数据集为Medicare受益者数据库。