Flaks-Manov Natalie, Shadmi Efrat, Hoshen Moshe, Balicer Ran D
Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel.
Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
J Hosp Med. 2016 Jun;11(6):401-6. doi: 10.1002/jhm.2535. Epub 2015 Dec 29.
Readmission to a different hospital than the original discharge hospital may result in breakdowns in continuity of care. In different-hospital readmissions (DHRs), continuity can be maintained when hospitals are connected through health information exchange (HIE) systems.
To examine whether length of readmission stay (LORS) differs between same-hospital readmissions and DHRs, and whether in DHRs the LORS differs by the availability of HIE.
A retrospective cohort study of all internal medicine 30-day readmissions in 27 Israeli hospitals between January 1, 2010 and December 31, 2010.
Clalit Health Services-Israel's largest integrated healthcare provider and payer.
Adult Clalit members (aged 18 and older) with at least 1 readmission during the study period.
A multivariate marginal Cox model tested the likelihood for discharge during each readmission day in same-hospital readmissions (SHRs), DHRs with HIE, and DHRs without HIE.
Of the 27,057 readmissions, 3130 (11.6%) were DHRs and 792 where DHRs with HIE in both the index and readmitting hospital. Partial continuity (DHRs with HIE) was associated with decreased likelihood of discharge on any given day compared with full continuity (SHRs) (hazard ratio [HR] = 0.85, 95% confidence interval [CI]: 0.79-0.91). Similar results were obtained for no continuity (DHRs without HIE) versus full continuity (HR = 0.90, 95% CI: 0.86-0.94). The difference between DHRs with and without HIE was not significant.
The prolonged LORS in DHRs versus SHRs was not mitigated by the existence of HIE systems. Future research is needed to further elucidate the effects of actual use of HIE on length of DHRs. Journal of Hospital Medicine 2016;11:401-406. © 2015 Society of Hospital Medicine.
再次入院时入住与原出院医院不同的医院可能导致医疗连续性中断。在不同医院再次入院（DHR）的情况下，当医院通过健康信息交换（HIE）系统连接时，连续性可以得到维持。
研究再次住院时间（LORS）在同医院再次入院和不同医院再次入院之间是否存在差异，以及在不同医院再次入院中，再次住院时间是否因HIE的可用性而有所不同。
对2010年1月1日至2010年12月31日期间以色列27家医院所有内科30天再次入院病例进行回顾性队列研究。
克拉利特医疗服务公司——以色列最大的综合医疗服务提供商和支付方。
在研究期间至少有一次再次入院的成年克拉利特会员（年龄在18岁及以上）。
采用多变量边际Cox模型测试同医院再次入院（SHR）、有HIE的不同医院再次入院（DHR）和无HIE的不同医院再次入院在每次再次住院日的出院可能性。
在27057例再次入院病例中，3130例（11.6%）为不同医院再次入院，其中792例在索引医院和再次入院医院均有HIE。与完全连续性（同医院再次入院）相比，部分连续性（有HIE的不同医院再次入院）在任何给定日期的出院可能性降低（风险比[HR]=0.85，95%置信区间[CI]：0.79 - 0.91）。无连续性（无HIE的不同医院再次入院）与完全连续性相比也得到了类似结果（HR = 0.90，95% CI：0.86 - 0.94）。有HIE和无HIE的不同医院再次入院之间的差异不显著。
不同医院再次入院与同医院再次入院相比延长的再次住院时间并未因HIE系统的存在而得到缓解。需要进一步的研究来阐明HIE的实际使用对不同医院再次住院时间的影响。《医院医学杂志》2016年；11：401 - 406。©2015医院医学协会。
