Arbaje Alicia I, Wolff Jennifer L, Yu Qilu, Powe Neil R, Anderson Gerard F, Boult Chad
Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
Gerontologist. 2008 Aug;48(4):495-504. doi: 10.1093/geront/48.4.495.
This study attempts to determine the associations between postdischarge environmental (PDE) and socioeconomic (SES) factors and early readmission to hospitals.
This study was a cohort study using the 2001 Medicare Current Beneficiary Survey and Medicare claims for the period from 2001 to 2002. The participants were community-dwelling Medicare beneficiaries admitted to hospitals, discharged home, and surviving at least 1 year after discharge (n = 1,351). The study measurements were early readmission (within 60 days), PDE factors, and SES factors. PDE factors consisted of having a usual source of care, requiring assistance to see the usual source of care, marital status, living alone, lacking self-management skills, having unmet functional need, having no helpers with activities of daily living, number of living children, and number of levels in the home. SES factors consisted of education, income, and Medicaid enrollment.
Of the 1,351 beneficiaries, 202 (15.0%) experienced an early readmission. After adjustment for demographics, health, and functional status, the odds of early readmission were increased by living alone (odds ratio or OR = 1.50, 95% confidence interval or CI = 1.01-2.24), having unmet functional need (OR = 1.48, 95% CI = 1.04-2.10), lacking self-management skills (OR = 1.44, 95% CI = 1.03-2.02), and having limited education (OR = 1.42, 95% CI = 1.01-2.02).
These findings suggest that PDE and SES factors are associated with early readmission. Considering these findings may enhance the targeting of pre-discharge and postdischarge interventions to avert early readmission. Such interventions may include home health services, patient activation, and comprehensive discharge planning.
本研究旨在确定出院后环境（PDE）和社会经济（SES）因素与早期再入院之间的关联。
本研究是一项队列研究，使用了2001年医疗保险当前受益调查以及2001年至2002年期间的医疗保险理赔数据。参与者为入住医院、出院回家且出院后存活至少1年的社区居住医疗保险受益人（n = 1351）。研究测量指标为早期再入院（60天内）、PDE因素和SES因素。PDE因素包括有常规医疗服务来源、前往常规医疗服务来源需要协助、婚姻状况、独居、缺乏自我管理技能、有未满足的功能需求、日常生活活动无帮手、在世子女数量以及家中楼层数。SES因素包括教育程度、收入和医疗补助登记情况。
在1351名受益人中，202人（15.0%）经历了早期再入院。在对人口统计学、健康状况和功能状态进行调整后，独居（优势比或OR = 1.50，95%置信区间或CI = 1.01 - 2.24）、有未满足的功能需求（OR = 1.48，95% CI = 1.04 - 2.10）、缺乏自我管理技能（OR = 1.44，95% CI = 1.03 - 2.02）以及教育程度有限（OR = 1.42，95% CI = 1.01 - 2.02）会增加早期再入院的几率。
这些发现表明PDE和SES因素与早期再入院有关。考虑这些发现可能会加强出院前和出院后干预措施的针对性，以避免早期再入院。此类干预措施可能包括家庭健康服务、患者激活以及全面的出院计划。
