Donzé Jacques D, Lipsitz Stuart, Schnipper Jeffrey L
Bern University Hospital, Bern, Switzerland; Brigham and Women's Hospital; and Harvard Medical School, Boston, MA.
J Oncol Pract. 2017 Jan;13(1):e68-e76. doi: 10.1200/JOP.2016.011445. Epub 2016 Oct 23.
Patients with cancer are particularly at risk for readmission within 30-days after discharge. To identify the patients who might benefit from more-intensive discharge interventions, we identified the risk factors associated with 30-day potentially avoidable readmissions.
We included all consecutive discharges from the oncology division of an academic tertiary medical center in Boston, Massachusetts, between July 1, 2009, and June 30, 2010. Potentially avoidable 30-day readmissions to the index hospital and two other hospitals within its network were identified. We performed a multivariable logistic regression in which the final model included variables found in bivariable testing to be significantly associated with the outcome.
Among the 2,916 patients discharged during the study period, 1,086 (37.3%) were readmitted within 30 days. Of these, 341 (31.4% of all readmissions, 11.7% of all discharges) were identified as potentially avoidable. In the multivariable analysis, the following patient factors were associated with a significantly higher risk of a potentially avoidable readmission: total number of medications at discharge, liver disease, last sodium level, and last hemoglobin level before discharge. In addition, potentially avoidable readmissions occurred significantly earlier than unavoidable readmissions (median, 10 v 13 days; P < .001).
Almost 40% of patients with cancer had a 30-day readmission, and almost one third of these were deemed potentially avoidable, and several risk factors for this were identified. Interventions at discharge may be prioritized to patients with these risk factors.
癌症患者在出院后30天内再次入院的风险尤其高。为了确定哪些患者可能从更强化的出院干预中获益，我们确定了与30天内潜在可避免再次入院相关的风险因素。
我们纳入了2009年7月1日至2010年6月30日期间马萨诸塞州波士顿一家学术性三级医疗中心肿瘤科室的所有连续出院患者。确定了索引医院及其网络内另外两家医院的30天潜在可避免再次入院情况。我们进行了多变量逻辑回归分析，最终模型纳入了在双变量检验中发现与结果显著相关的变量。
在研究期间出院的2916例患者中，1086例（37.3%）在30天内再次入院。其中，341例（占所有再次入院患者的31.4%，占所有出院患者的11.7%）被确定为潜在可避免的。在多变量分析中，以下患者因素与潜在可避免再次入院的风险显著较高相关：出院时用药总数、肝病、末次钠水平以及出院前末次血红蛋白水平。此外，潜在可避免再次入院的发生时间明显早于不可避免再次入院（中位数分别为10天和13天；P <.001）。
近40%的癌症患者在30天内再次入院，其中近三分之一被认为是潜在可避免的，并且确定了与此相关的几个风险因素。出院时的干预措施可能应优先针对具有这些风险因素的患者。
