Department of Internal Medicine and Aged Care, Herston, Queensland, Australia.
J Hosp Med. 2011 Feb;6(2):61-7. doi: 10.1002/jhm.811. Epub 2010 Oct 12.
Hospital readmissions are common and costly. A recent previous hospitalization preceding the index admission is a marker of increased risk of future readmission.
To identify factors associated with an increased risk of recurrent readmission in medical patients with 2 or more hospitalizations in the past 6 months.
Prospective cohort study.
Australian teaching hospital acute medical wards, February 2006-February 2007.
142 inpatients aged ≥ 50 years with a previous hospitalization ≤ 6 months preceding the index admission. Patients from residential care, with terminal illness, or with serious cognitive or language difficulties were excluded.
Demographics, previous hospitalizations, diagnosis, comorbidities and nutritional status were recorded in hospital. Participants were assessed at home within 2 weeks of hospital discharge using validated questionnaires for cognition, literacy, activities of daily living (ADL)/instrumental activities of daily living (IADL) function, depression, anxiety, alcohol use, medication adherence, social support, and financial status.
Unplanned readmission to the study hospital within 6 months.
A total of 55 participants (38.7%) had a further unplanned hospital admission within 6 months. In multivariate analysis, chronic disease (adjusted odds ratio [OR] 3.4; 95% confidence interval [CI], 1.3-9.3, P = 0.002), depressive symptoms (adjusted OR, 3.0; 95% CI, 1.3-6.8, P = 0.01), and underweight (adjusted OR, 12.7; 95% CI, 2.3-70.7, P = 0.004) were significant predictors of readmission after adjusting for age, length of stay and functional status.
In this high-risk patient group, multiple chronic conditions are common and predict increased risk of readmission. Post-hospital interventions should consider targeting nutritional and mood status in this population.
医院再入院很常见且费用高昂。近期在索引入院前的先前住院是未来再入院风险增加的标志。
确定过去 6 个月内有 2 次或以上住院史的内科患者再次住院的风险增加的相关因素。
前瞻性队列研究。
澳大利亚教学医院急性内科病房，2006 年 2 月至 2007 年 2 月。
142 名年龄≥50 岁的住院患者，在索引入院前≤6 个月内有过先前住院史。排除来自养老院、患有终末期疾病或有严重认知或语言障碍的患者。
人口统计学、先前的住院情况、诊断、合并症和营养状况在医院记录。出院后 2 周内，使用经过验证的认知、读写能力、日常生活活动（ADL）/工具性日常生活活动（IADL）功能、抑郁、焦虑、饮酒、药物依从性、社会支持和经济状况的问卷，对参与者进行家庭评估。
6 个月内计划外再次入住研究医院。
共有 55 名（38.7%）患者在 6 个月内再次发生非计划住院。多变量分析显示，慢性疾病（调整后的优势比[OR] 3.4；95%置信区间[CI]，1.3-9.3，P = 0.002）、抑郁症状（调整后的 OR，3.0；95% CI，1.3-6.8，P = 0.01）和体重不足（调整后的 OR，12.7；95% CI，2.3-70.7，P = 0.004）是调整年龄、住院时间和功能状态后再入院的显著预测因素。
在这个高风险患者群体中，多种慢性疾病很常见，并且预测再入院风险增加。住院后干预措施应考虑针对该人群的营养和情绪状况。
