Dantas Inês, Santana Rui, Sarmento João, Aguiar Pedro
National School of Public Health (ENSP), Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal.
Department of Health Policy and Systems Management, National School of Public Health (ENSP), Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal.
BMC Health Serv Res. 2016 Aug 4;16(a):348. doi: 10.1186/s12913-016-1584-2.
The high financial burden of avoidable hospitalizations has led to an increase of the study of hospitalizations for ambulatory care sensitive conditions (ACSC). There is limited information on the impact of secondary diagnoses on these hospitalizations, although patients' social and demographic characteristics, as well as the coexistence of multiple diseases are often identified in the literature as risk factors for avoidable hospitalizations. This study explores the impact of chronic conditions on the likelihood of hospitalizations for ACSC.
Data were extracted from the Portuguese hospital discharge database. Avoidable hospitalizations were identified according to the Canadian Institute for Healthcare Information, and chronic conditions were identified according to criteria set by the Agency for Healthcare Research and Quality. A retrospective study analysing all patients hospitalized for an ACSC and all patients hospitalized for non-ACSC was made, using multiple logistic regression models to identify the impact of chronic conditions on the risk of admission.
The risk of an avoidable hospitalization increases by a factor of 1.35 (95 % CI [1.34;1.35]) for each additional chronic condition, and 1.55 (95 % CI [1.55;1.56]) for each additional body system affected. The respiratory and circulatory systems have the most impact on the risk of ACSC, increasing the risk by 8.72 (95 % CI [8.58;8.86]) and 3.01 (95 % CI [2.95;3.06]), respectively.
The number of chronic conditions and the body systems affected increase the risk of hospital admissions for ACSC.
可避免住院的高昂经济负担促使对门诊护理敏感型疾病（ACSC）住院治疗的研究有所增加。关于次要诊断对这些住院治疗的影响的信息有限，尽管患者的社会和人口统计学特征以及多种疾病并存的情况在文献中常被确定为可避免住院的风险因素。本研究探讨慢性病对ACSC住院可能性的影响。
数据从葡萄牙医院出院数据库中提取。根据加拿大医疗信息研究所的标准确定可避免住院情况，根据医疗保健研究与质量局设定的标准确定慢性病。进行了一项回顾性研究，分析所有因ACSC住院的患者和所有因非ACSC住院的患者，使用多元逻辑回归模型确定慢性病对入院风险的影响。
每增加一种慢性病，可避免住院的风险增加1.35倍（95%置信区间[1.34；1.35]），每增加一个受影响的身体系统，风险增加1.55倍（95%置信区间[1.55；1.56]）。呼吸系统和循环系统对ACSC风险的影响最大，分别使风险增加8.72倍（95%置信区间[8.58；8.86]）和3.01倍（95%置信区间[2.95；3.06]）。
慢性病的数量和受影响的身体系统会增加ACSC住院的风险。
