学术医疗中心附属医院严重脓毒症住院后的非计划再入院情况。
Unplanned Readmissions After Hospitalization for Severe Sepsis at Academic Medical Center-Affiliated Hospitals.
作者信息
Donnelly John P, Hohmann Samuel F, Wang Henry E
机构信息
1Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL. 2Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL. 3Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL. 4University HealthSystem Consortium, Chicago, IL. 5Department of Health Systems Management, Rush University, Chicago, IL.
出版信息
Crit Care Med. 2015 Sep;43(9):1916-27. doi: 10.1097/CCM.0000000000001147.
OBJECTIVE
In the United States, national efforts to reduce hospital readmissions have been enacted, including the application of substantial insurance reimbursement penalties for hospitals with elevated rates. Readmissions after severe sepsis remain understudied and could possibly signify lapses in care and missed opportunities for intervention. We sought to characterize 7- and 30-day readmission rates following hospital admission for severe sepsis as well as institutional variations in readmission.
DESIGN
Retrospective analysis of 345,657 severe sepsis discharges from University HealthSystem Consortium hospitals in 2012.
SETTING
United States.
PATIENTS
We applied the commonly cited method described by Angus et al for identification of severe sepsis, including only discharges with sepsis present at admission.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We identified unplanned, all-cause readmissions within 7 and 30 days of discharge using claims-based algorithms. Using mixed-effects logistic regression, we determined factors associated with 30-day readmission. We used risk-standardized readmission rates to assess institutional variations. Among 216,328 eligible severe sepsis discharges, there were 14,932 readmissions within 7 days (6.9%; 95% CI, 6.8-7.0) and 43,092 within 30 days (19.9%; 95% CI, 19.8-20.1). Among those readmitted within 30 days, 66.9% had an infection and 40.3% had severe sepsis at readmission. Patient severity, length of stay, and specific diagnoses were associated with increased odds of 30-day readmission. Observed institutional 7-day readmission rates ranged from 0% to 12.3%, 30-day rates from 3.6% to 29.1%, and 30-day risk-standardized readmission rates from 14.1% to 31.1%. Greater institutional volume, teaching status, trauma services, location in the Northeast, and lower ICU rates were associated with poor risk-standardized readmission rate performance.
CONCLUSIONS
Severe sepsis readmission places a substantial burden on the healthcare system, with one in 15 and one in five severe sepsis discharges readmitted within 7 and 30 days, respectively. Hospitals and clinicians should be aware of this important sequela of severe sepsis.
目的
在美国，已开展全国性努力以降低医院再入院率，包括对再入院率较高的医院实施高额保险报销处罚。严重脓毒症后的再入院情况仍未得到充分研究，这可能意味着护理失误以及干预机会的错失。我们试图描述严重脓毒症住院后7天和30天的再入院率以及再入院情况的机构差异。
设计
对2012年大学卫生系统联盟医院345,657例严重脓毒症出院病例进行回顾性分析。
地点
美国。
患者
我们采用了安格斯等人描述的常用方法来识别严重脓毒症，仅纳入入院时存在脓毒症的出院病例。
干预措施
无。
测量指标及主要结果
我们使用基于索赔的算法确定出院后7天和30天内的非计划全因再入院情况。使用混合效应逻辑回归，我们确定了与30天再入院相关的因素。我们使用风险标准化再入院率来评估机构差异。在216,328例符合条件的严重脓毒症出院病例中，7天内有14,932例再入院（6.9%；95%CI，6.8 - 7.0），30天内有43,092例再入院（19.9%；95%CI，19.8 - 20.1）。在30天内再入院的患者中，66.9%有感染，40.3%在再入院时有严重脓毒症。患者病情严重程度、住院时间和具体诊断与30天再入院几率增加相关。观察到的机构7天再入院率范围为0%至12.3%，30天再入院率范围为3.6%至29.1%，30天风险标准化再入院率范围为14.1%至31.1%。机构规模越大、教学地位、创伤服务、位于东北部以及ICU使用率较低与风险标准化再入院率表现较差相关。
结论
严重脓毒症再入院给医疗系统带来了沉重负担，严重脓毒症出院病例中分别有十五分之一和五分之一在7天和30天内再入院。医院和临床医生应意识到严重脓毒症的这一重要后遗症。
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