School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
BMC Health Serv Res. 2011 Aug 10;11:186. doi: 10.1186/1472-6963-11-186.
Chronic Obstructive Pulmonary Disease (COPD) accounts for around 4% of all public hospital annual admissions in Hong Kong. By year 2020, COPD will be ranked fifth among the conditions with the highest burden to the society. This study identifies admission and unplanned readmission of COPD patients, factors affecting unplanned readmission, and estimates its cost burden on the public healthcare system in Hong Kong.
This is a retrospective study analyzing COPD admissions to all public hospitals in Hong Kong. All admission episodes to acute medical wards with the principal diagnosis of COPD (ICD-9:490-492, 494-496) from January 2006 to December 2007 were captured. Unplanned readmission was defined as an admission which followed a previous admission within 30 days.
In 2006 and 2007, 65497 (8.0%) of episodes from medical wards were identified as COPD admissions, and among these, 15882 (24.2%) were unplanned readmissions. The mean age of COPD patients was 76.81 ± 9.59 years and 77% were male. Unplanned readmission was significantly associated with male gender, receiving public assistance and living in nursing homes while no association was found with the Charlson comorbidity index. Patients who were readmitted unplanned had a significant longer acute length of stay (β = 0.3894, P < 0.001) after adjustment for other covariates.
Unplanned readmission of COPD patients has a huge impact on the public healthcare system. A systematic approach in programme provision and a good discharge planning process targeting on COPD patients who are at high risk of unplanned readmission are essential.
在香港，慢性阻塞性肺疾病（COPD）约占所有公立医院年住院人数的 4%。到 2020 年，COPD 将成为对社会负担最重的第五大疾病。本研究旨在确定 COPD 患者的入院和非计划性再入院情况、影响非计划性再入院的因素，并估算其对香港公共医疗体系的成本负担。
这是一项回顾性研究，分析了香港所有公立医院的 COPD 入院情况。从 2006 年 1 月至 2007 年 12 月，共纳入所有以 COPD（ICD-9：490-492、494-496）为主要诊断的内科急性病房的入院病例。非计划性再入院定义为在 30 天内再次入院。
2006 年和 2007 年，内科病房共收治 65497 例 COPD 患者，其中 15882 例（24.2%）为非计划性再入院。COPD 患者的平均年龄为 76.81 ± 9.59 岁，其中 77%为男性。非计划性再入院与男性、接受公共援助和居住在养老院显著相关，而与 Charlson 合并症指数无关。在校正其他混杂因素后，与计划性再入院相比，非计划性再入院患者的急性住院时间显著延长（β=0.3894，P<0.001）。
COPD 患者的非计划性再入院对公共医疗体系造成了巨大影响。针对非计划性再入院风险较高的 COPD 患者，提供系统的方案和良好的出院计划至关重要。
