Background: 

Given the inclusion of orthopaedic quality measures in the Centers for Medicare & Medicaid Services national hospital payment programs, the present study sought to assess whether the public reporting of total hip arthroplasty (THA) and total knee arthroplasty (TKA) risk-standardized readmission rates (RSRRs) and complication rates (RSCRs) was temporally associated with a decrease in the rates of these outcomes among Medicare beneficiaries.

Methods: 

Annual trends in national observed and hospital-level RSRRs and RSCRs were evaluated for patients who underwent hospital-based inpatient hip and/or knee replacement procedures from fiscal year 2010 to fiscal year 2016. Hospital-level rates were calculated with use of the same measures and methodology that were utilized in public reporting. Annual trends in the distribution of hospital-level outcomes were then examined with use of density plots.

Results: 

Complication and readmission rates and variation declined steadily from fiscal year 2010 to fiscal year 2016. Reductions of 33% and 25% were noted in hospital-level RSCRs and RSRRs, respectively. The interquartile range decreased by 18% (relative reduction) for RSCRs and by 34% (relative reduction) for RSRRs. The frequency of risk variables in the complication and readmission models did not systematically change over time, suggesting no evidence of widespread bias or up-coding.

Conclusions: 

This study showed that hospital-level complication and readmission rates following THA and TKA and the variation in hospital-level performance declined during a period coinciding with the start of public reporting and financial incentives associated with measurement. The consistently decreasing trend in rates of and variation in outcomes suggests steady improvements and greater consistency among hospitals in clinical outcomes for THA and TKA patients in the 2016 fiscal year compared with the 2010 fiscal year. The interactions between public reporting, payment, and hospital coding practices are complex and require further study.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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髋关节和膝关节置换术后质量测量公开报告与改善的结果相关

背景： 

考虑到医疗保险和医疗补助服务中心的国家医院付款计划中包含了骨科质量衡量指标，本研究旨在评估是否公开报告了全髋关节置换术（THA）和全膝关节置换术（TKA）的风险标准化再入院率（ RSRRs和并发症发生率（RSCRs）在时间上与Medicare受益人中这些结局发生率的降低相关。

方法： 

从2010会计年度到2016会计年度，对接受医院住院的髋部和/或膝关节置换手术的患者，评估了全国观察到的和医院一级的RSRR和RSCR的年度趋势。使用相同的方法来计算医院一级的比率和在公共报告中使用的方法。然后使用密度图检查医院水平结局分布的年度趋势。

结果： 

从2010财年到2016财年，并发症和再入院率及变异率稳步下降。医院一级的RSCR和RSRR分别降低了33％和25％。RSCR的四分位数范围减少了18％（相对减少），RSRR的减少了34％（相对减少）。并发症和再入院模型中风险变量的频率没有随时间而系统地改变，这表明没有证据表明存在广泛的偏见或向上编码。

结论： 

这项研究表明，在THA和TKA之后的医院级并发症和再入院率以及医院级绩效的变化在一段时间内下降，这与开始进行公共报告和与测量相关的财务激励措施相吻合。与2010财年相比，2016财年THA和TKA患者的临床结局稳步提高，并且结局率不断下降的趋势表明医院之间的稳定改善和一致性。公共报告，付款和医院编码实践之间的交互非常复杂，需要进一步研究。

证据级别： 

预后III级。有关证据水平的完整说明，请参见《作者说明》。