Palepu Anita, Sun Huiying, Kuyper Laura, Schechter Martin T, O'Shaughnessy Michael V, Anis Aslam H
Received from the Department of Internal Medicine, the Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
J Gen Intern Med. 2003 Apr;18(4):242-7. doi: 10.1046/j.1525-1497.2003.20720.x.
Although hospitalization patterns have been studied, little is known about hospital readmission among HIV-infected patients in the era of highly active antiretroviral therapy. We explored the risk factors for early readmission to a tertiary care inner-city hospital among HIV-infected patients with pneumonia in Vancouver, Canada.
Case-control study.
Tertiary care, university-affiliated, inner-city hospital.
All HIV-infected patients who were hospitalized with Pneumocystis carinii pneumonia (PCP) or bacterial pneumonia (BP) between January 1997 and December 2000. Case patients included those who had early readmissions, defined as being readmitted within 2 weeks of discharge (N = 131). Control patients were randomly selected HIV-infected patients admitted during the study period who were not readmitted within 2 weeks of discharge (N = 131), matched to the cases by proportion of PCP to BP.
Sociodemographic, HIV risk category, and clinical data were compared using chi2 test for categorical variables, and the Wilcoxon rank-sum test was used for continuous variables. Multivariable logistic regression was performed to determine the factors independently associated with early readmission. We also reviewed the medical records of 132 patients admitted to the HIV/AIDS ward during the study period and collected more detailed clinical data for a subanalysis.
Patients were at significantly increased odds of early readmission if they left the hospital against medical advice (AMA) (adjusted odds ratio [OR], 4.26; 95% confidence interval [95% CI], 2.13 to 8.55), lived in the poorest urban neighborhood (OR, 2.03; 95% CI, 1.09 to 3.77), were hospitalized in summer season (May though October, OR, 2.36; 95% CI, 1.36 to 4.10), or had been admitted in the preceding 6 months (OR, 2.55; 95% CI, 1.46 to 4.47). Gender, age, history of AIDS-defining illness, and injection drug use status were not significantly associated with early readmission.
Predictors of early readmission of HIV-infected patients with pneumonia included: leaving hospital AMA, living in the poorest urban neighborhood, being hospitalized in the preceding 6 months and during the summer months. Interventions involving social work may address some of the underlying reasons why these patients leave hospital AMA and should be further studied.
尽管已对住院模式进行研究，但在高效抗逆转录病毒治疗时代，对HIV感染患者再次入院情况却知之甚少。我们探讨了加拿大温哥华HIV感染且患肺炎的患者再次入住一家市中心三级护理医院的危险因素。
病例对照研究。
一所与大学相关的市中心三级护理医院。
1997年1月至2000年12月期间因卡氏肺孢子虫肺炎（PCP）或细菌性肺炎（BP）住院的所有HIV感染患者。病例组患者包括那些早期再次入院的患者，定义为出院后2周内再次入院（n = 131）。对照组患者为研究期间入院的未在出院后2周内再次入院的随机选取的HIV感染患者（n = 131），按PCP与BP的比例与病例组匹配。
使用卡方检验比较分类变量的社会人口统计学、HIV风险类别和临床数据，使用Wilcoxon秩和检验比较连续变量。进行多变量逻辑回归以确定与早期再次入院独立相关的因素。我们还查阅了研究期间入住HIV/AIDS病房的132例患者的病历，并收集了更详细的临床数据用于亚组分析。
如果患者违反医嘱（AMA）出院（校正比值比[OR]，4.26；95%置信区间[95%CI]，2.13至8.55）、居住在最贫困的城市社区（OR，2.03；95%CI，1.09至3.77）、在夏季（5月至10月）住院（OR，2.36；95%CI，1.36至4.10）或在过去6个月内曾入院（OR，2.55；95%CI，1.46至4.47），则其早期再次入院的几率显著增加。性别、年龄、艾滋病定义疾病史和注射吸毒状况与早期再次入院无显著关联。
HIV感染且患肺炎患者早期再次入院的预测因素包括：违反医嘱出院、居住在最贫困的城市社区、在过去6个月内及夏季住院。涉及社会工作的干预措施可能会解决这些患者违反医嘱出院的一些潜在原因，应进一步研究。
