医院人群病例组合（包括贫困因素）对医院全因及感染相关30天再入院率的影响。
Impact of Hospital Population Case-Mix, Including Poverty, on Hospital All-Cause and Infection-Related 30-Day Readmission Rates.
作者信息
Gohil Shruti K, Datta Rupak, Cao Chenghua, Phelan Michael J, Nguyen Vinh, Rowther Armaan A, Huang Susan S
机构信息
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine.
Department of Medicine, Yale School of Medicine.
出版信息
Clin Infect Dis. 2015 Oct 15;61(8):1235-43. doi: 10.1093/cid/civ539. Epub 2015 Jun 30.
BACKGROUND
Reducing hospital readmissions, including preventable healthcare-associated infections, is a national priority. The proportion of readmissions due to infections is not well-understood. Better understanding of hospital risk factors for readmissions and infection-related readmissions may help optimize interventions to prevent readmissions.
METHODS
Retrospective cohort study of California acute care hospitals and their patient populations discharged between 2009 and 2011. Demographics, comorbidities, and socioeconomic status were entered into a hierarchical generalized linear mixed model predicting all-cause and infection-related readmissions. Crude verses adjusted hospital rankings were compared using Cohen's kappa.
RESULTS
We assessed 30-day readmission rates from 323 hospitals, accounting for 213 879 194 post-discharge person-days of follow-up. Infection-related readmissions represented 28% of all readmissions and were associated with discharging a high proportion of patients to skilled nursing facilities. Hospitals serving populations with high proportions of males, comorbidities, prolonged length of stay, and populations living in a federal poverty area, had higher all-cause and infection-related readmission rates. Academic hospitals had higher all-cause and infection-related readmission rates (odds ratio 1.24 and 1.15, respectively). When comparing adjusted vs crude hospital rankings for infection-related readmission rates, adjustment revealed 31% of hospitals changed performance category for infection-related readmissions.
CONCLUSIONS
Infection-related readmissions accounted for nearly 30% of all-cause readmissions. High hospital infection-related readmissions were associated with serving a high proportion of patients with comorbidities, long lengths of stay, discharge to skilled nursing facility, and those living in federal poverty areas. Preventability of these infections needs to be assessed.
背景
降低医院再入院率，包括可预防的医疗相关感染，是一项国家优先事项。因感染导致的再入院比例尚未得到充分了解。更好地了解医院再入院的风险因素以及与感染相关的再入院情况，可能有助于优化预防再入院的干预措施。
方法
对2009年至2011年期间加利福尼亚州急性护理医院及其出院患者群体进行回顾性队列研究。将人口统计学、合并症和社会经济状况纳入分层广义线性混合模型，以预测全因再入院和与感染相关的再入院情况。使用科恩kappa系数比较粗率与调整后的医院排名。
结果
我们评估了323家医院的30天再入院率，随访的出院后人次为213879194人日。与感染相关的再入院占所有再入院的28%，并与将高比例患者转至专业护理机构有关。服务于男性比例高、合并症多、住院时间延长以及生活在联邦贫困地区人群的医院，全因再入院率和与感染相关的再入院率更高。学术医院的全因再入院率和与感染相关的再入院率更高（优势比分别为1.24和1.15）。在比较与感染相关的再入院率的调整后与粗率医院排名时，调整显示31%的医院在与感染相关的再入院方面改变了绩效类别。
结论
与感染相关的再入院占全因再入院的近30%。医院与感染相关的高再入院率与服务高比例的合并症患者、住院时间长、转至专业护理机构以及生活在联邦贫困地区的患者有关。需要评估这些感染的可预防性。
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