Hospital readmission is considered a core measure of quality in healthcare. Readmission soon after hospital discharge can result from suboptimal care during the index hospitalization or from inadequate systems for postdischarge care. For many conditions, readmission is associated with a high rate of serious morbidity and potentially avoidable costs. In obstetrics, for postpartum care specifically, hospitals and payers can easily track the rate of maternal readmission after childbirth and may seek to incentivize obstetricians, maternal-fetal medicine specialists, or provider groups to reduce the rate of readmission. However, this practice has not been shown to improve outcomes or reduce harm. There are major concerns with incentivizing providers to reduce postpartum readmissions, including the lack of a standardized metric, a baseline rate of 1% to 2% that is too low to accurately discriminate between random variation and controllable factors, the need for risk adjustment that greatly complicates rate calculations, the potential for bias depending on the duration of the follow-up interval, the potential for the “gaming” of the metric, the lack of evidence that obstetrical providers can influence the rate, and the potential for unintended harm in the vulnerable postpartum population. Until these problems are adequately addressed, maternal readmission rate after a childbirth hospitalization currently has limited utility as a metric for quality or performance improvement or as a factor to adjust provider reimbursement.

再入院被认为是医疗保健质量的核心衡量标准。出院后不久再入院可能是由于住院期间的护理不理想或出院后护理系统不足。对于许多情况，再入院与高发病率和潜在可避免的成本相关。在产科，特别是产后护理，医院和付款人可以轻松追踪产妇产后再入院率，并可能寻求激励产科医生、母胎医学专家或提供者团体降低再入院率。然而，这种做法并没有被证明可以改善结果或减少伤害。激励提供者减少产后再入院存在主要问题，包括缺乏标准化的指标，1% 到 2% 的基线率太低，无法准确区分随机变化和可控因素，需要进行风险调整，这会使比率计算变得非常复杂，可能存在偏差，具体取决于随访间隔的持续时间，该指标的“游戏”潜力，缺乏证据表明产科提供者可以影响产率，以及对易受伤害的产后人群造成意外伤害的可能性。在这些问题得到充分解决之前，分娩住院后的产妇再入院率目前作为衡量质量或性能改进的指标或作为调整提供者报销的因素的效用有限。需要进行风险调整，这使费率计算变得非常复杂，可能存在偏差，具体取决于随访间隔的持续时间，指标“游戏”的可能性，缺乏证据表明产科提供者可以影响费率，以及对易受伤害的产后人群造成意外伤害的可能性。在这些问题得到充分解决之前，分娩住院后的产妇再入院率目前作为衡量质量或性能改进的指标或作为调整提供者报销的因素的效用有限。需要进行风险调整，这使费率计算变得非常复杂，可能存在偏差，具体取决于随访间隔的持续时间，指标“游戏”的可能性，缺乏证据表明产科提供者可以影响费率，以及对易受伤害的产后人群造成意外伤害的可能性。在这些问题得到充分解决之前，分娩住院后的产妇再入院率目前作为衡量质量或性能改进的指标或作为调整提供者报销的因素的效用有限。以及对易受伤害的产后人群造成意外伤害的可能性。在这些问题得到充分解决之前，分娩住院后的产妇再入院率目前作为衡量质量或性能改进的指标或作为调整提供者报销的因素的效用有限。以及对易受伤害的产后人群造成意外伤害的可能性。在这些问题得到充分解决之前，分娩住院后的产妇再入院率目前作为衡量质量或性能改进的指标或作为调整提供者报销的因素的效用有限。