San Francisco General Hospital and University of California, San Francisco.
Arthritis Rheumatol. 2014 Oct;66(10):2828-36. doi: 10.1002/art.38768.
Systemic lupus erythematosus (SLE) has one of the highest hospital readmission rates among chronic conditions. This study was undertaken to identify patient-level, hospital-level, and geographic predictors of 30-day hospital readmissions associated with SLE.
Using hospital discharge databases from 5 geographically dispersed states, we studied all-cause readmission of SLE patients between 2008 and 2009. We evaluated each hospitalization as a possible index event leading up to a readmission, our primary outcome. We accounted for clustering of hospitalizations within patients and within hospitals and adjusted for hospital case mix. Using multilevel mixed-effects logistic regression, we examined factors associated with 30-day readmission and calculated risk-standardized hospital-level and state-level readmission rates.
We examined 55,936 hospitalizations among 31,903 patients with SLE. Of these hospitalizations, 9,244 (16.5%) resulted in readmission within 30 days. In adjusted analyses, age was inversely related to risk of readmission. African American and Hispanic patients were more likely to be readmitted than white patients, as were those with Medicare or Medicaid insurance (versus private insurance). Several clinical characteristics of lupus, including nephritis, serositis, and thrombocytopenia, were associated with readmission. Readmission rates varied significantly between hospitals after accounting for patient-level clustering and hospital case mix. We also found geographic variation, with risk-adjusted readmission rates lower in New York and higher in Florida as compared to California.
We found that ~1 in 6 hospitalized patients with SLE were readmitted within 30 days of discharge, with higher rates among historically underserved populations. Significant geographic and hospital-level variation in risk-adjusted readmission rates suggests potential for quality improvement.
红斑狼疮（SLE）是慢性病中住院再入院率最高的疾病之一。本研究旨在确定与 SLE 相关的 30 天内住院再入院的患者水平、医院水平和地理因素预测指标。
我们使用来自 5 个地理分散州的医院出院数据库，研究了 2008 年至 2009 年间所有导致 SLE 患者再入院的原因。我们将每次住院视为导致再入院的可能索引事件，这是我们的主要结果。我们考虑了患者和医院内住院的聚类，并调整了医院病例组合。我们使用多水平混合效应逻辑回归分析了与 30 天再入院相关的因素，并计算了风险标准化的医院和州再入院率。
我们研究了 31903 名 SLE 患者的 55936 次住院。其中，9244 次（16.5%）在 30 天内再次住院。在调整后的分析中，年龄与再入院风险呈反比。与白人患者相比，非裔美国人和西班牙裔患者更有可能再次住院，而拥有医疗保险或医疗补助的患者（而非私人保险）也是如此。狼疮的几种临床特征，包括肾炎、浆膜炎和血小板减少症，与再入院有关。在考虑到患者水平聚类和医院病例组合后，医院间的再入院率差异显著。我们还发现了地理差异，与加利福尼亚州相比，纽约州和佛罗里达州的风险调整后再入院率较低，而佛罗里达州的再入院率较高。
我们发现，大约每 6 名住院的 SLE 患者中有 1 名在出院后 30 天内再次住院，在历史上服务不足的人群中再入院率更高。风险调整后再入院率的显著地理和医院水平差异表明存在质量改进的潜力。
