居家医疗出院后 30 天内再住院的风险因素：一项接受肠外营养治疗患者的队列研究。

Risk factors of 30-days re-hospitalization after Hospital at Home in a cohort of patients treated with parenteral therapy.

机构信息

Department of Public Health, Aarhus University, Bartholins Allé 2 - Building 1260, 8000 Aarhus C, Denmark.

Department of Social Medicine, Faculty of Medicine, Aalborg University Hospital, Havrevangen 1, 2nd floor, 9000 Aalborg, Denmark; Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Niels Jernes Vej 14, 2nd floor, 9220 Aalborg Ø, Denmark.

出版信息

Eur J Intern Med. 2014 Dec;25(10):895-9. doi: 10.1016/j.ejim.2014.10.018. Epub 2014 Nov 5.

DOI:10.1016/j.ejim.2014.10.018

PMID:25468737

Abstract

BACKGROUND

Hospital at Home provides acute medical treatment in the patient's home. To prevent re-hospitalization in these outpatients, it is decisive to identify high-risk groups. This study aimed to identify patient characteristics for increased risk of 30 days re-hospitalization, after referral to Hospital at Home.

METHODS

A registry-based study was conducted using information from a hospital and a team providing Hospital at Home treatment. A total of 379 patients above the age of 18, who had received parenteral therapy by the team, in the period 01.03.2011 to 31.12.2012, were identified. Comorbid conditions were defined using Charlson's Comorbidity Index and divided into groups of score (0, 1 and ≥ 2). Cox regression analysis was used to estimate a risk of 30 days re-hospitalization by computing the hazard ratios (HR) with 95% confidence interval (95% CI).

RESULTS

Within 30 days after referral to Hospital at Home 32.5% of the population was re-hospitalized. An increased risk of readmission was found in patients with a comorbidity score ≥ 2 (HR 2.06, 95% CI 1.33-3.18) and in patients referred to Hospital at Home from a hospital department (HR 1.56, 95% CI 1.02-2.38). Primary care tended to reduce the risk of readmission although not significant (HR 0.65, 95% CI 0.41-1.04).

CONCLUSIONS

This study suggests that, patients with comorbidities and/or patients referred by the hospital are in a greater risk of readmission. Further readmission may be prevented in patients receiving primary care.

摘要

背景

医院居家提供患者家中的急性医疗服务。为了防止这些门诊患者再次住院，识别高危人群至关重要。本研究旨在确定患者特征，以增加医院居家治疗后 30 天内再次住院的风险。

方法

本研究采用基于登记的研究方法，利用一家医院和一个提供医院居家治疗的团队的信息。共确定了 2011 年 3 月 1 日至 2012 年 12 月 31 日期间，年龄在 18 岁以上、接受过团队肠外治疗的 379 名患者。合并症使用 Charlson 合并症指数定义，并分为评分（0、1 和≥2）组。使用 Cox 回归分析计算风险比（HR）及其 95%置信区间（95%CI），以估计 30 天内再次住院的风险。

结果

在转诊至医院居家治疗后 30 天内，人群中有 32.5%再次住院。发现合并症评分≥2 的患者（HR 2.06，95%CI 1.33-3.18）和从医院科室转诊至医院居家的患者（HR 1.56，95%CI 1.02-2.38）再次入院的风险增加。初级保健有降低再入院风险的趋势，但无统计学意义（HR 0.65，95%CI 0.41-1.04）。