患者相关因素与频繁再入院：病情、服务可及性和患者选择的影响。
Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice.
机构信息
Centre for Primary Health Care & Equity, School of Public Health & Community Medicine, University of New South Wales, UNSW, Sydney, NSW, Australia.
出版信息
BMC Health Serv Res. 2010 Jul 21;10:216. doi: 10.1186/1472-6963-10-216.
BACKGROUND
People use emergency department services for a wide variety of health complaints, many of which could be handled outside hospitals. Many frequent readmissions are due to problems with chronic disease and are preventable. We postulated that patient related factors such as the type of condition, demographic factors, access to alternative services outside hospitals and patient preference for hospital or non-hospital services would influence readmissions for chronic disease. This study aimed to explore the link between frequent readmissions in chronic disease and these patient related factors.
METHODS
A retrospective analysis was performed on emergency department data collected from a regional hospital in NSW Australia in 2008. Frequently readmitted patients were defined as those with three or more admissions in a year. Clinical, service usage and demographic patient characteristics were examined for their influence on readmissions using multivariate analysis.
RESULTS
The emergency department received about 20,000 presentations a year involving some 16,000 patients. Most patients (80%) presented only once. In 2008 one hundred and forty four patients were readmitted three or more times in a year. About 20% of all presentations resulted in an admission. Frequently readmitted patients were more likely to be older, have an urgent Triage classification, present with an unplanned returned visit and have a diagnosis of neurosis, chronic obstructive pulmonary disease, dyspnoea or chronic heart failure. The chronic ambulatory care sensitive conditions were strongly associated with frequent readmissions. Frequent readmissions were unrelated to gender, time, day or season of presentation or country of birth.
CONCLUSIONS
Multivariate analysis of routinely collected hospital data identified that the factors associated with frequent readmission include the type of condition, urgency, unplanned return visit and age. Interventions to improve patient uptake of chronic disease management services and improving the availability of alternative non-hospital services should reduce the readmission rate in chronic disease patients.
背景
人们因各种健康问题前往急诊科就诊，其中许多问题在医院之外就能得到解决。许多患者频繁再入院是由于慢性病问题导致的，这些情况本可以预防。我们推测，患者相关因素，如疾病类型、人口统计学因素、医院外获得替代服务的机会以及患者对医院或非医院服务的偏好，会影响慢性病患者的再入院率。本研究旨在探讨慢性病频繁再入院与这些患者相关因素之间的联系。
方法
我们对 2008 年澳大利亚新南威尔士州一家地区医院急诊科收集的急诊数据进行了回顾性分析。频繁再入院患者定义为一年内住院 3 次或以上的患者。我们使用多变量分析方法，检查了临床、服务使用和人口统计学患者特征对再入院的影响。
结果
急诊科每年接待约 2 万名患者，涉及约 1.6 万名患者。大多数患者（80%）仅就诊 1 次。2008 年，有 144 名患者一年内住院 3 次或以上。约 20%的就诊患者需要入院治疗。频繁再入院患者更有可能是老年人，有紧急分诊分类，以非计划复诊就诊，且患有神经症、慢性阻塞性肺疾病、呼吸困难或慢性心力衰竭。慢性门诊医疗敏感状况与频繁再入院密切相关。频繁再入院与性别、时间、就诊日或季节或出生地无关。
结论
对常规收集的医院数据进行多变量分析，确定与频繁再入院相关的因素包括疾病类型、紧急程度、非计划复诊和年龄。干预措施应改善患者对慢性病管理服务的接受程度，并增加替代非医院服务的供应，以降低慢性病患者的再入院率。
Zotero 插件