Scott I A, Shohag H, Ahmed M
Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2014 Feb;44(2):161-70. doi: 10.1111/imj.12334.
Unplanned readmissions befall up to 25% of acutely hospitalised older patients, and many may be potentially preventable.
To assess the type and prevalence of quality of care factors associated with potentially preventable readmissions to a tertiary hospital general medicine service.
A retrospective case-control study was undertaken of hospital records of patients 65 years or older admitted acutely between 1 January 2005 and 31 December 2010. Readmissions up to 30 days postdischarge (cases) were purposively sampled according to frequencies of primary discharge diagnoses coded during the study period. Non-readmitted patients (controls), matched according to age, sex and primary discharge diagnosis on index admission, were selected in a 1.7:1 ratio.
One hundred and thirteen cases and 198 controls were analysed, the former demonstrating a significantly higher comorbidity burden (mean (±standard deviation) comorbidity score 6.6 (±2.2) vs 5.6 (±2.4), P = 0.003) and a higher proportion of individuals with one or more hospitalisations over the preceding 6 months (55.7% vs 8.1%, P < 0.001). Among readmitted patients, 50 (44.3%) were associated with one or more quality factors versus 23 (11.6%) controls (P < 0.001). The most common were: failure to develop/activate an advance care plan (18, 15.9% vs 2, 1.0%; P < 0.001); suboptimal management of presenting illness (13, 11.4% vs 0, 0%; P < 0.001); inadequate assessment of functional limitations (11, 9.7% vs 0, 0%; P < 0.001); and potentially preventable complication of therapy (8, 7.1% vs 1, 0.5%, P = 0.002).
Quality of care factors are more common among readmitted than among non-readmitted older patients suggesting potential for remedial strategies. Such strategies may still have limited effects as older, frail patients with advanced diseases and multimorbidity will likely retain a high propensity for readmission despite optimal care.
高达25%的急性住院老年患者会发生非计划再入院情况，其中许多可能是可以预防的。
评估与三级医院普通内科服务潜在可预防再入院相关的护理质量因素的类型和患病率。
对2005年1月1日至2010年12月31日期间急性入院的65岁及以上患者的医院记录进行回顾性病例对照研究。根据研究期间编码的主要出院诊断频率，有目的地抽取出院后30天内的再入院患者（病例）。按照年龄、性别和首次入院时的主要出院诊断进行匹配的非再入院患者（对照），以1.7:1的比例选取。
分析了113例病例和198例对照，前者的合并症负担显著更高（平均（±标准差）合并症评分6.6（±2.2）对5.6（±2.4），P = 0.003），且在过去6个月内有一次或多次住院的个体比例更高（55.7%对8.1%，P < 0.001）。在再入院患者中，50例（44.3%）与一个或多个质量因素相关，而对照中有23例（11.6%）（P < 0.001）。最常见的因素有：未制定/启动预先护理计划（18例，15.9%对2例，1.0%；P < 0.001）；当前疾病管理欠佳（13例，11.4%对0例，0%；P < 0.001）；对功能受限评估不足（11例，9.7%对0例，0%；P < 0.001）；以及治疗中潜在可预防的并发症（8例，7.1%对1例，0.5%，P = 0.002）。
护理质量因素在再入院老年患者中比非再入院患者中更常见，这表明有采取补救策略的可能性。尽管采取了最佳护理措施，但患有晚期疾病和多种合并症的老年体弱患者可能仍有较高的再入院倾向，因此这些策略的效果可能仍然有限。
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