Pfizer Inc, New York, NY, USA.
Boehringer-Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA.
Int J Chron Obstruct Pulmon Dis. 2013;8:551-9. doi: 10.2147/COPD.S51507. Epub 2013 Nov 12.
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalizations and readmissions in the US. Reducing the frequency of hospital readmission is a high priority of US health care organizations and government agencies. This study evaluated the risk factors associated with readmissions among commercially insured adults aged 40-65 years in the US who were hospitalized for COPD.
This retrospective cohort study used anonymized claims data from the Truven Health MarketScan® Commercial Claims and Encounters database. The patients included were aged 40-65 years, had an index hospitalization with a primary diagnosis of COPD between July 1, 2008 and June 30, 2010 (continuously enrolled 12 months before and after), and were alive at hospital discharge. Patients with cystic fibrosis or tuberculosis or who were transferred to another inpatient facility after hospital discharge were excluded. All readmissions regardless of diagnosis, and separately a subset of all readmissions that had COPD as a primary or secondary diagnosis (COPD-related), were examined. Univariate descriptive statistics and multivariable regression methods were used.
Of the 18,568 patients with index COPD hospitalizations, 6,095 (32.83%) met the eligibility criteria. Of those, 503 (8.25%) were readmitted within the first 30 days post-index hospitalization and 2,527 (41.46%) within the first year (COPD-related 340 [5.58%] and 1,681 [27.58%], respectively). The median time to the first readmission post initial discharge was 4.0 months, with a mean of 5.0 ± 3.4 months. Multivariable regression analyses showed that comorbid conditions and health care utilization in the pre-index period were significant predictors for readmission both 30 and 90 days following index hospitalization.
A relatively high readmission rate was observed for patients aged 40-65 years. The results suggest that attention to patient comorbidities and pre-index/index health care service utilization may help identify hospitalized COPD patients at higher risk for readmission.
慢性阻塞性肺疾病（COPD）急性加重是美国住院和再入院的主要原因。降低医院再入院率是美国医疗保健组织和政府机构的首要任务。本研究评估了在美国 40-65 岁因 COPD 住院的商业保险成年人再入院的相关风险因素。
本回顾性队列研究使用了 Truven Health MarketScan®商业索赔和就诊数据库的匿名索赔数据。纳入的患者年龄在 40-65 岁之间，2008 年 7 月 1 日至 2010 年 6 月 30 日期间因 COPD 住院，有主要诊断，在索引住院前 12 个月和后 12 个月连续入组，出院时存活。排除患有囊性纤维化或结核病或出院后转至其他住院设施的患者。所有再入院均不考虑诊断，并且单独检查所有再入院中 COPD 为主要或次要诊断的子集（COPD 相关）。使用单变量描述性统计和多变量回归方法。
在 18568 例 COPD 住院患者中，有 6095 例（32.83%）符合入选标准。其中，有 503 例（8.25%）在索引住院后 30 天内再次入院，有 2527 例（41.46%）在一年内再次入院（COPD 相关分别为 340 例[5.58%]和 1681 例[27.58%]）。首次出院后首次再入院的中位时间为 4.0 个月，平均为 5.0 ± 3.4 个月。多变量回归分析显示，在索引前期间合并症和卫生保健利用情况是索引后 30 天和 90 天再次入院的重要预测因素。
观察到年龄在 40-65 岁的患者的再入院率相对较高。结果表明，关注患者的合并症和索引前/索引期间的卫生保健服务利用情况可能有助于识别再入院风险较高的 COPD 住院患者。
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