Melbourne EpiCentre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia.
Department of Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Int J Geriatr Psychiatry. 2017 May;32(5):539-547. doi: 10.1002/gps.4491. Epub 2016 Apr 25.
To compare healthcare utilisation outcomes among older hospitalised patients with and without cognitive impairment, and to compare the costs associated with these outcomes.
Retrospective cohort study of administrative data from a large teaching hospital in Melbourne, Australia from 1 July 2006 to 30 June 2012. People with cognitive impairment were defined as having dementia or delirium coded during the admission. Outcome measures included length of stay, unplanned readmissions within 28 days and costs associated with these outcomes. Regression analysis was used to compare differences between those with and without cognitive impairment.
There were 93 300 hospital admissions included in the analysis. 6459 (6.9%) involved cognitively impaired patients. The adjusted median length of stay was significantly higher for the cognitively impaired group compared with the non-cognitively impaired group (7.4 days 6.7-10.0 vs 6.6 days, interquartile range 5.7-8.3; p < 0.001). There were no differences in odds of 28-day readmission. When only those discharged back to their usual residence were included in the analysis, the risk of 28-day readmission was significantly higher for those with cognitive impairment compared with those without. The cost of admissions involving patients with cognitive impairment was 51% higher than the cost of those without cognitive impairment.
Hospitalised people with cognitive impairment experience significantly greater length of stay and when discharged to their usual residence are more likely to be readmitted to hospital within 28 days compared with those without cognitive impairment. The costs associated with hospital episodes and 28-day readmissions are significantly higher for those with cognitive impairment. Copyright © 2016 John Wiley & Sons, Ltd.
比较伴有和不伴有认知障碍的老年住院患者的医疗保健利用结果，并比较这些结果相关的成本。
这是一项回顾性队列研究，使用来自澳大利亚墨尔本一家大型教学医院的行政数据，时间为 2006 年 7 月 1 日至 2012 年 6 月 30 日。认知障碍患者的定义为在入院期间患有痴呆或谵妄。结果测量包括住院时间、28 天内的非计划性再入院及这些结果相关的成本。使用回归分析比较有认知障碍和无认知障碍患者之间的差异。
共有 93300 例住院患者纳入分析，其中 6459 例（6.9%）患者存在认知障碍。调整后的认知障碍组的中位住院时间明显长于无认知障碍组（7.4 天，6.7-10.0 比 6.6 天，四分位距 5.7-8.3；p<0.001）。28 天内再入院的几率无差异。当仅分析出院后返回常住地的患者时，认知障碍患者 28 天内再入院的风险显著高于无认知障碍患者。伴有认知障碍的住院患者的入院成本比无认知障碍患者高 51%。
患有认知障碍的住院患者的住院时间明显延长，当出院返回常住地时，28 天内再次入院的风险比无认知障碍患者更高。与无认知障碍患者相比，认知障碍患者的住院相关费用和 28 天内再入院的费用显著增加。
