Rationale: Chronic obstructive pulmonary disease (COPD) is the fifth-leading cause of admissions and third-leading cause of readmissions among U.S. adults. Recent policies instituted financial penalties for excessive COPD readmissions. Objectives: To evaluate changes in the quality of care for patients hospitalized for COPD after implementation of the Hospital Readmissions Reduction Program (HRRP). Methods: We conducted a retrospective cohort study of patients older than 40 years of age hospitalized for COPD across 995 U.S. hospitals (Premier Healthcare Database). Measurements and Main Results: Quality of care before and after HRRP implementation was measured via adherence to recommended inpatient care treatments for acute exacerbations of COPD (recommended care, nonrecommended care, "ideal care" [all recommended and no nonrecommended care]). We included 662,842 pre-HRRP (January 2010-September 2014) and 285,508 post-HRRP (October 2014-December 2018) admissions. Recommended care increased at a rate of 0.16% per month pre-HRRP and 0.01% per month post-HRRP (P < 0.001). Nonrecommended care decreased at a rate of 0.15% per month pre-HRRP and 0.13% per month post-HRRP. Ideal care increased at a rate of 0.24% per month pre-HRRP and 0.11% per month post-HRRP (P < 0.001). Conclusions: The pre-HRRP trends toward improving care quality for inpatient COPD care slowed after HRRP implementation. This suggests that financial penalties for readmissions did not stimulate higher quality of care for patients hospitalized with COPD. It remains unclear what policies or approaches will be effective to ensure high care quality for patients hospitalized with COPD exacerbations.

中文翻译：

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再入院处罚时代慢性阻塞性肺疾病患者的护理质量。


理由：慢性阻塞性肺疾病 (COPD) 是美国成年人入院的第五大原因和再入院的第三大原因。最近的政策对过度的慢性阻塞性肺病再入院实施了经济处罚。目的：评估实施再入院减少计划 (HRRP) 后因慢性阻塞性肺病 (COPD) 住院患者的护理质量变化。方法：我们对美国 995 家医院因慢性阻塞性肺病住院的 40 岁以上患者进行了回顾性队列研究（Premier Healthcare 数据库）。测量和主要结果：HRRP 实施前后的护理质量是通过遵守针对 COPD 急性加重推荐的住院护理治疗（推荐护理、非推荐护理、“理想护理”[所有推荐且无非推荐护理]）来衡量的。我们纳入了 HRRP 前（2010 年 1 月至 2014 年 9 月）的 662,842 名入院者和 HRRP 后（2014 年 10 月至 2018 年 12 月）的 285,508 名入院者。 HRRP 前推荐护理每月增加 0.16%，HRRP 后每月推荐护理增加 0.01%（P < 0.001）。 HRRP 前的非推荐护理每月减少 0.15%，HRRP 后每月减少 0.13%。 HRRP 前的理想护理每月增加 0.24%，HRRP 后每月增加 0.11%（P < 0.001）。结论：HRRP 实施前改善住院 COPD 护理质量的趋势在 HRRP 实施后放缓。这表明，对再入院的经济处罚并没有刺激因慢性阻塞性肺病住院的患者获得更高质量的护理。目前尚不清楚哪些政策或方法将有效确保因慢性阻塞性肺病恶化而住院的患者获得高质量的护理。