Fleishman John A, Moore Richard D, Conviser Richard, Lawrence Perrin B, Korthuis P Todd, Gebo Kelly A
Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA.
Health Serv Res. 2008 Feb;43(1 Pt 1):76-95. doi: 10.1111/j.1475-6773.2007.00750.x.
To examine the prospective association between frequency of outpatient visits and subsequent inpatient admissions.
Medical record data on 13,942 patients with HIV infection seen in 10 HIV speciality care sites across the United States.
This observational study followed a cohort of HIV-infected patients who were in care in the first half of 2001. Numbers of inpatient admissions and outpatient visits were calculated for each patient for each 3-month period, from 2001 through 2004.
Negative binomial and logistic regression analyses using random-effects models examined the effects of inpatient admissions and outpatient visits in the previous period on inpatient and outpatient service utilization, controlling for background characteristics and HIV disease stage.
For 3-month periods, between 5 and 9 percent of patients had an inpatient admission. The linear association between number of outpatient visits and any inpatient admission in the subsequent period was positive (adjusted odds ratio=1.05; 95 percent confidence interval [CI]=1.04, 1.06). However, patients with zero prior outpatient visits had significantly greater admission rates than those with one prior visit. Hospitalization rates were also higher among those with a prior hospitalization and those with more advanced HIV disease.
These results suggest a J-shaped relationship between outpatient use and inpatient use among persons with HIV disease. Those in worse health have greater utilization of both inpatient and outpatient care. However, having no outpatient visits may also increase the likelihood of subsequent hospitalization. Although outpatient care cannot be justified as a cost-saving mechanism, maintaining regular clinical monitoring of patients is important.
研究门诊就诊频率与随后住院治疗之间的前瞻性关联。
来自美国10个艾滋病专科护理点的13942例艾滋病毒感染患者的病历数据。
这项观察性研究追踪了2001年上半年接受治疗的一组艾滋病毒感染患者。计算了每位患者在2001年至2004年期间每3个月的住院次数和门诊就诊次数。
使用随机效应模型的负二项式和逻辑回归分析，在控制背景特征和艾滋病毒疾病阶段的情况下，研究上一时期的住院次数和门诊就诊次数对住院和门诊服务利用的影响。
在3个月期间，5%至9%的患者有住院治疗。门诊就诊次数与随后任何一次住院之间的线性关联为正（调整后的优势比=1.05；95%置信区间[CI]=1.04，1.06）。然而，之前门诊就诊次数为零的患者的住院率明显高于有过一次门诊就诊的患者。有过住院史和艾滋病毒疾病更严重的患者的住院率也更高。
这些结果表明，艾滋病毒感染者的门诊使用和住院使用之间呈J形关系。健康状况较差的人对住院和门诊护理的利用率更高。然而，没有门诊就诊也可能增加随后住院的可能性。虽然门诊护理不能作为一种节省成本的机制，但对患者进行定期临床监测很重要。
