医疗保险受益人因心力衰竭住院后，与 30 天再入院相关的早期医生随访情况。

Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure.

机构信息

Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA.

出版信息

JAMA. 2010 May 5;303(17):1716-22. doi: 10.1001/jama.2010.533.

DOI:10.1001/jama.2010.533

PMID:20442387

Abstract

CONTEXT

Readmission after hospitalization for heart failure is common. Early outpatient follow-up after hospitalization has been proposed as a means of reducing readmission rates. However, there are limited data describing patterns of follow-up after heart failure hospitalization and its association with readmission rates.

OBJECTIVE

To examine associations between outpatient follow-up within 7 days after discharge from a heart failure hospitalization and readmission within 30 days.

DESIGN, SETTING, AND PATIENTS: Observational analysis of patients 65 years or older with heart failure and discharged to home from hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure and the Get With the Guidelines-Heart Failure quality improvement program from January 1, 2003, through December 31, 2006.

MAIN OUTCOME MEASURE

All-cause readmission within 30 days after discharge.

RESULTS

The study population included 30,136 patients from 225 hospitals. Median length of stay was 4 days (interquartile range, 2-6) and 21.3% of patients were readmitted within 30 days. At the hospital level, the median percentage of patients who had early follow-up after discharge from the index hospitalization was 38.3% (interquartile range, 32.4%-44.5%). Compared with patients whose index admission was in a hospital in the lowest quartile of early follow-up (30-day readmission rate, 23.3%), the rates of 30-day readmission were 20.5% among patients in the second quartile (risk-adjusted hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.78-0.93), 20.5% among patients in the third quartile (risk-adjusted HR, 0.87; 95% CI, 0.78-0.96), and 20.9% among patients in the fourth quartile (risk-adjusted HR, 0.91; 95% CI, 0.83-1.00).

CONCLUSIONS

Among patients who are hospitalized for heart failure, substantial variation exists in hospital-level rates of early outpatient follow-up after discharge. Patients who are discharged from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00344513.

摘要

背景

心力衰竭患者住院后再入院较为常见。出院后早期门诊随访已被提议作为降低再入院率的一种手段。然而，描述心力衰竭患者住院后随访模式及其与再入院率之间关系的数据有限。

目的

探讨心力衰竭患者出院后 7 天内门诊随访与 30 天内再入院之间的关联。

设计、地点和患者：对 2003 年 1 月 1 日至 2006 年 12 月 31 日期间参与有组织的启动住院心力衰竭患者救生治疗计划和 Get With the Guidelines-Heart Failure 质量改进计划的医院出院至家中的年龄在 65 岁或以上的心力衰竭患者进行观察性分析。

主要结局测量

出院后 30 天内全因再入院。

结果

研究人群包括来自 225 家医院的 30136 名患者。中位住院时间为 4 天（四分位间距，2-6），21.3%的患者在 30 天内再入院。在医院层面，出院后早期随访的患者中位数百分比为 38.3%（四分位间距，32.4%-44.5%）。与指数住院期间在早期随访最低四分位（30 天再入院率为 23.3%）的患者相比，指数住院期间在早期随访最低四分位的患者的 30 天再入院率分别为：第二四分位（风险调整后的危险比[HR]，0.85；95%置信区间[CI]，0.78-0.93）为 20.5%，第三四分位（风险调整后 HR，0.87；95% CI，0.78-0.96）为 20.5%，第四四分位（风险调整后 HR，0.91；95% CI，0.83-1.00）为 20.9%。