急性缺血性中风患者出院后1个月内的再入院情况：大学卫生系统联盟中风基准研究结果
Readmission within 1 month of discharge among patients with acute ischemic stroke: results of the University HealthSystem Consortium Stroke Benchmarking study.
作者信息
Suri M Fareed K, Qureshi Adnan I
机构信息
Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Vasc Interv Neurol. 2013 Dec;6(2):47-51.
BACKGROUND
The University HealthSystem Consortium (UHC) recently conducted a benchmarking project to identify variations in processes of care and clinical resource management, identify new patterns in practice, and distinguish opportunities for improvement among UHC hospitals.
METHODS
We performed this analysis to determine the rate of and factors associated with readmission within 1 month of discharge among patients with acute ischemic stroke. A retrospective review of 40 consecutive ischemic stroke cases meeting inclusion criteria and discharge between January 1st and June 30th, 2004 was conducted in 32 hospitals. We performed a multivariate analysis to identify demographic and clinical factors associated with readmission among patients with ischemic stroke.
RESULTS
A total of 1018 patients (mean age 66 years, range 18-98 years), who were discharged from the hospital and had follow-up available, were analyzed. A total of 90 (9%) of these patients were readmitted within 1 month of discharge. Common reasons for readmission were recurrent stroke (24%), infection (12%), chest pain or myocardial infarction (10%), worsening of stroke symptoms (7%), arrhythmias (7%), and congestive heart failure (3%). In univariate analysis, older patients (P = 0.03) and those discharged home without health care were more likely to be readmitted (P = 0.04). In the multivariate analysis, age was the only predictor for readmission. For each decade older age, there was a 19% increase in odds of readmission. Patient's race/ethnicity, presence of cardiovascular risk factors, and severity of stroke, insurance status, neurology consultation, discharge destination were not associated with readmission.
CONCLUSIONS
In the present multicenter study, 9% of the discharged patients with ischemic stroke were readmitted within a 1 month. Several etiologies for readmission were identified to assist in implementing quality improvement strategies.
背景
大学健康系统联盟（UHC）最近开展了一项基准项目，以确定护理流程和临床资源管理方面的差异，识别实践中的新模式，并区分UHC各医院之间的改进机会。
方法
我们进行了此项分析，以确定急性缺血性中风患者出院后1个月内的再入院率及相关因素。对2004年1月1日至6月30日期间在32家医院出院的40例连续符合纳入标准的缺血性中风病例进行了回顾性研究。我们进行了多变量分析，以确定缺血性中风患者再入院的人口统计学和临床因素。
结果
共分析了1018例出院且有随访资料的患者（平均年龄66岁，范围18 - 98岁）。其中90例（9%）患者在出院后1个月内再次入院。再入院的常见原因包括复发性中风（24%）、感染（12%）、胸痛或心肌梗死（10%）、中风症状恶化（7%）、心律失常（7%）和充血性心力衰竭（3%）。单变量分析显示，老年患者（P = 0.03）和出院回家且无医疗护理的患者更有可能再次入院（P = 0.04）。多变量分析中，年龄是再入院的唯一预测因素。每增加一个十岁年龄组，再入院几率增加19%。患者的种族/民族、心血管危险因素的存在、中风严重程度、保险状况、神经科会诊、出院目的地与再入院无关。
结论
在本多中心研究中，9%的缺血性中风出院患者在1个月内再次入院。确定了几种再入院病因，以协助实施质量改进策略。
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