Yu Tzy-Chyi, Zhou Huanxue, Suh Kangho, Arcona Stephen
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
KMK Consulting Inc., Florham Park, NJ, USA.
Clinicoecon Outcomes Res. 2015 Jan 6;7:37-51. doi: 10.2147/CEOR.S74181. eCollection 2015.
The all-cause readmission rate within 30 days of index admissions for chronic obstructive pulmonary disease (COPD) was approximately 21% in the United States in 2008. This study aimed to examine patient and clinical characteristics predicting 30-day unplanned readmissions for an initial COPD hospitalization and to determine those predictors' importance.
A retrospective study was conducted in patients with COPD-related hospitalizations using commercial claims data from 2010 to 2012. The primary outcome was all-cause unplanned readmission, with secondary outcomes being COPD as primary diagnosis and COPD as any diagnosis unplanned readmissions. Factors predicting unplanned readmissions encompassed demographic, pharmacy, and medical variables identified at baseline and during the index hospitalization. Dominance analysis was conducted to rank the predictors in terms of importance, defined as the contribution to change in model fit of a predictor by itself and in combination with other predictors.
After applying the inclusion and exclusion criteria, 18,282 patients with index COPD-related admissions were identified. Among them, the rates of unplanned readmissions with COPD as primary diagnosis, COPD as any diagnosis, and all-cause were 2.6%, 5.6%, and 7.3%, respectively. For each outcome, the readmission group was slightly older, had a greater COPD severity score, and required a longer length of stay. Moreover, the readmission group had larger proportions of patients with comorbidities, dyspnea/shortness of breath, intensive care unit stay, or ventilator use, compared to the non-readmission group. Dominance analysis revealed that the three most important predictors - heart failure/heart disease, anemia, and COPD severity score - accounted for 56% of the predicted variance in all-cause unplanned readmissions.
Overall, COPD severity score and heart failure/heart disease emerged as important factors in predicting 30-day unplanned readmissions across all three outcomes. Results from dominance analysis suggest looking beyond COPD-specific complications and focusing on comorbid conditions highly associated with COPD in order to lower all-cause unplanned readmissions.
2008年美国慢性阻塞性肺疾病（COPD）首次住院后30天内的全因再入院率约为21%。本研究旨在检查预测首次COPD住院30天内非计划再入院的患者和临床特征，并确定这些预测因素的重要性。
利用2010年至2012年的商业索赔数据，对因COPD住院的患者进行了一项回顾性研究。主要结局是全因非计划再入院，次要结局是以COPD作为主要诊断的非计划再入院以及以COPD作为任何诊断的非计划再入院。预测非计划再入院的因素包括在基线和首次住院期间确定的人口统计学、药学和医学变量。进行了优势分析，以根据重要性对预测因素进行排名，重要性定义为一个预测因素自身以及与其他预测因素组合时对模型拟合变化的贡献。
应用纳入和排除标准后，确定了18282例首次因COPD相关入院的患者。其中，以COPD作为主要诊断的非计划再入院率、以COPD作为任何诊断的非计划再入院率和全因非计划再入院率分别为2.6%、5.6%和7.3%。对于每种结局，再入院组的患者年龄稍大，COPD严重程度评分更高，住院时间更长。此外，与非再入院组相比，再入院组中合并症、呼吸困难/呼吸急促、入住重症监护病房或使用呼吸机的患者比例更高。优势分析显示，三个最重要的预测因素——心力衰竭/心脏病、贫血和COPD严重程度评分——占全因非计划再入院预测方差的56%。
总体而言，COPD严重程度评分和心力衰竭/心脏病是预测所有三种结局30天内非计划再入院的重要因素。优势分析结果表明，应超越COPD特异性并发症，关注与COPD高度相关的合并症，以降低全因非计划再入院率。
