Demir Eren, Chaussalet Thierry J, Xie Haifeng, Millard Peter H
Health and Social Care Modelling Group, Department of Information Systems and Computing, School of Informatics, University of Westminster, London W1W 6UW, UK.
IEEE Trans Inf Technol Biomed. 2008 Sep;12(5):644-9. doi: 10.1109/TITB.2007.911311.
A frequently chosen time window in defining readmission is 28 days after discharge. Yet in the literature, shorter and longer periods such as 14 days or 90-180 days have also been suggested. In this paper, we develop a modeling approach that systematically tackles the issue surrounding the appropriate choice of a time window as a definition of readmission. The approach is based on the intuitive idea that patients who are discharged from hospital can be broadly divided in to two groups-a group that is at high risk of readmission and a group that is at low risk. Using the national data (England), we demonstrate the usefulness of the approach in the case of chronic obstructive pulmonary disease (COPD), stroke, and congestive heart failure (CHF) patients, which are known to be the leading causes of early readmission. Our findings suggest that there are marked differences in the optimal width of the time window for COPD, stroke, and CHF patients. Furthermore, time windows and the probabilities of being in the high-risk group for COPD, stroke, and CHF patients for each of the 29 acute and specialist trusts in the London area indicate wide variability between hospitals. The novelty of this modeling approach lies in its ability to define an appropriate time window based on evidence objectively derived from operational data. Therefore, it can separately provide a unique approach in examining variability between hospitals, and potentially contribute to a better definition of readmission as a performance indicator.
定义再入院时常用的时间窗口是出院后28天。然而，在文献中，也有人提出了更短或更长的时间段，如14天或90 - 180天。在本文中，我们开发了一种建模方法，系统地解决围绕选择适当时间窗口作为再入院定义的问题。该方法基于一个直观的想法，即出院患者大致可分为两组——再入院高风险组和低风险组。利用国家数据（英国），我们证明了该方法在慢性阻塞性肺疾病（COPD）、中风和充血性心力衰竭（CHF）患者中的有用性，这些疾病是早期再入院的主要原因。我们的研究结果表明，COPD、中风和CHF患者的最佳时间窗口宽度存在显著差异。此外，伦敦地区29个急性和专科信托机构中，COPD、中风和CHF患者的时间窗口以及处于高风险组的概率表明医院之间存在很大差异。这种建模方法的新颖之处在于它能够根据从运营数据客观得出的证据来定义适当的时间窗口。因此，它可以分别提供一种独特的方法来检查医院之间的差异，并有可能有助于更好地将再入院定义为一个绩效指标。
