Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada.
BMC Health Serv Res. 2013 Oct 9;13:399. doi: 10.1186/1472-6963-13-399.
Re-hospitalization is common among patients with diabetes, and may be related to aspects of health care use. We sought to determine the association between patterns of health care engagement and risk of subsequent hospitalization within one year of discharge for patients with diabetes.
We identified adults with incident diabetes in Alberta, Canada, who had at least one hospitalization following their diabetes diagnosis between January 1, 2004 and March 31, 2011. We used Cox regression to estimate the association between factors related to health care engagement (prior emergency department use, primary care visits, and discharge disposition (i.e. whether the patient left against medical advice)) and the risk of subsequent all-cause hospitalization within one year.
Of the 33,811 adults with diabetes and at least one hospitalization, 11,095 (32.8%) experienced a subsequent all-cause hospitalization within a mean (standard deviation) follow-up time of 0.68 (0.3) years. Compared to patients with no emergency department visits, there was a 4 percent increased risk of a subsequent hospitalization for every emergency department visit occurring prior to the index hospitalization (adjusted Hazard Ratio [HR]: 1.04; 95% CI: 1.03-1.05). Limited and increased use of primary care was also associated with increased risk of a subsequent hospitalization. Compared to patients with 1-4 visits, patients with no visits to a primary care physician (adjusted HR: 1.11; 95% CI: 0.99-1.25) and those with 5-9 visits (adjusted HR: 1.06; 95% CI: 1.00-1.12) were more likely to experience a subsequent hospitalization. Finally, compared to patients discharged home, those leaving against medical advice were more likely to have a subsequent hospitalization (adjusted HR: 1.74; 95% CI: 1.50-2.02) and almost 3 times more likely to have a diabetes-specific subsequent event (adjusted HR: 2.86; 95% CI: 1.82-4.49).
Patterns of health care use and the circumstances surrounding hospital discharge are associated with an increased risk of subsequent hospitalization among patients with diabetes. Whether these patterns are related to the health care systems ability to manage complex patients within a primary care setting, or to access to primary care services, remains to be determined.
糖尿病患者再住院的情况较为常见，这可能与医疗保健使用的各方面相关。我们旨在确定在糖尿病患者出院后一年内，其医疗保健参与模式与随后住院的风险之间的关联。
我们在加拿大艾伯塔省确定了患有新发糖尿病的成年人，这些患者在 2004 年 1 月 1 日至 2011 年 3 月 31 日之间，在确诊糖尿病后至少有一次住院治疗。我们使用 Cox 回归来评估与医疗保健参与相关的因素（先前的急诊就诊、初级保健就诊和出院处置（即患者是否违反医嘱离开））与随后一年内全因住院的风险之间的关联。
在 33811 名至少有一次住院治疗的糖尿病成年人中，11095 名（32.8%）在平均（标准差）随访时间为 0.68（0.3）年期间发生了随后的全因住院治疗。与没有急诊就诊的患者相比，在指数住院治疗之前每次急诊就诊都会使随后住院的风险增加 4%（调整后的危害比[HR]：1.04；95%CI：1.03-1.05）。初级保健服务的利用有限或增加也与随后住院治疗的风险增加相关。与没有就诊的初级保健医生的患者相比（调整后的 HR：1.11；95%CI：0.99-1.25），就诊次数为 1-4 次的患者（调整后的 HR：1.06；95%CI：1.00-1.12）和就诊次数为 5-9 次的患者更有可能发生随后的住院治疗。最后，与出院回家的患者相比，违反医嘱出院的患者更有可能发生随后的住院治疗（调整后的 HR：1.74；95%CI：1.50-2.02），且发生糖尿病特定后续事件的风险几乎增加了 3 倍（调整后的 HR：2.86；95%CI：1.82-4.49）。
医疗保健利用模式和出院时的情况与糖尿病患者随后住院的风险增加相关。这些模式是否与初级保健环境中管理复杂患者的医疗保健系统能力有关，或者与初级保健服务的可及性有关，还有待确定。
