老年康复住院患者再住院的预测因素：药物使用种类、功能状态和住院时间的作用。
Predictors of rehospitalization among elderly patients admitted to a rehabilitation hospital: the role of polypharmacy, functional status, and length of stay.
机构信息
Department of Rehabilitation and Aged Care Hospital Ancelle, Cremona, Italy; Geriatric Research Group, Brescia, Italy; Center for Quality Aging, Department of Medicine, Vanderbilt University, Nashville, TN.
出版信息
J Am Med Dir Assoc. 2013 Oct;14(10):761-7. doi: 10.1016/j.jamda.2013.03.013. Epub 2013 May 7.
OBJECTIVES
Rehospitalizations for elderly patients are an increasing health care burden. Nonetheless, we have limited information on unplanned rehospitalizations and the related risk factors in elderly patients admitted to in-hospital rehabilitation facilities after an acute hospitalization.
SETTING
In-hospital rehabilitation and aged care unit.
DESIGN
Retrospective cohort study.
PARTICIPANTS
Elderly patients 65 years or older admitted to an in-hospital rehabilitation hospital after an acute hospitalization between January 2004 and June 2011.
MEASUREMENTS
The rate of 30-day unplanned rehospitalization to hospitals was recorded. Risk factors for unplanned rehospitalization were evaluated at rehabilitation admission: age, comorbidity, serum albumin, number of drugs, decline in functional status, delirium, Mini Mental State Examination score, and length of stay in the acute hospital. A multivariable Cox proportional regression model was used to identify the effect of these risk factors for time to event within the 30-day follow-up.
RESULTS
Among 2735 patients, with a median age of 80 years (interquartile range 74-85), 98 (4%) were rehospitalized within 30 days. Independent predictors of 30-day unplanned rehospitalization were the use of 7 or more drugs (hazard ratio [HR], 3.94; 95% confidence interval, 1.62-9.54; P = .002) and a significant decline in functional status (56 points or more at the Barthel Index) compared with the month before hospital admission (HR 2.67, 95% CI: 1.35-5.27; P = .005). Additionally, a length of stay in the acute hospital of 13 days or more carried a twofold higher risk of rehospitalization (HR 2.67, 95% CI: 1.39-5.10); P = .003).
CONCLUSIONS
The rate of unplanned rehospitalization was low in this study. Polypharmacy, a significant worsening of functional status compared with the month before acute hospital admission, and hospital length of stay are important risk factors.
目的
老年人的再住院是医疗保健负担不断增加的一个方面。然而，我们对于在急性住院后入住院内康复设施的老年患者的非计划性再住院及其相关危险因素知之甚少。
设置
院内康复和老年护理病房。
设计
回顾性队列研究。
参与者
2004 年 1 月至 2011 年 6 月期间，在急性住院后入住院内康复医院的 65 岁或以上的老年患者。
测量方法
记录 30 天内非计划性再住院至医院的比率。在康复入院时评估非计划性再住院的危险因素：年龄、合并症、血清白蛋白、药物数量、功能状态下降、谵妄、简易精神状态检查评分和急性医院的住院时间。使用多变量 Cox 比例风险回归模型来确定这些危险因素对 30 天随访内事件时间的影响。
结果
在 2735 名患者中，中位年龄为 80 岁（四分位间距 74-85 岁），98 名（4%）在 30 天内再次住院。30 天内非计划性再住院的独立预测因素是使用 7 种或更多药物（风险比 [HR]，3.94；95%置信区间，1.62-9.54；P=.002）和与入院前一个月相比功能状态显著下降（Barthel 指数增加 56 分或以上）（HR 2.67，95%可信区间：1.35-5.27；P=.005）。此外，急性医院住院时间为 13 天或更长时间与再住院风险增加两倍相关（HR 2.67，95%可信区间：1.39-5.10；P=.003）。
结论
本研究中的非计划性再住院率较低。多药治疗、与急性住院前一个月相比功能状态显著恶化以及住院时间是重要的危险因素。
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