Horney Carolyn, Capp Roberta, Boxer Rebecca, Burke Robert E
Department of Medicine, Division of Geriatric Medicine, University of Colorado, Aurora, Colorado.
Geriatric Section, Medicine Service, Denver VA Medical Center, Denver, Colorado.
J Am Geriatr Soc. 2017 Jun;65(6):1199-1205. doi: 10.1111/jgs.14758. Epub 2017 Mar 3.
Over a quarter of Medicare patients admitted to the hospital are discharged to post-acute care (PAC) facilities, but face high rates of readmission. Timing of readmission may be an important factor in identifying both risk for and preventability of future readmissions. This study aims to define factors associated with readmission within the first week of discharge to PAC facilities following hospitalization.
This was a secondary analysis of the 2011 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for California, Massachusetts, and Florida. The primary outcome was all-cause readmission within 7 days after hospital discharge, compared to readmission on days 8-30, for patients aged 65 and older who were discharged from the hospital to a PAC facility. Predictor variables included patient, index hospitalization, and hospital characteristics; multivariable logistic regression was used to identify significant predictors of readmission within 7 days.
There were 81,173 hospital readmissions from PAC facilities in the first 30 days after hospital discharge. Patients readmitted within the first week were older, white, urban, had fewer comorbid illnesses, had a higher number of previous hospital admissions, and less commonly had Medicare as a payer. Longer index hospital length of stay (LOS) was associated with decreased risk of early readmission (OR 0.74; 95% CI 0.70-0.74 for LOS 4-7 days and 0.60; 95% CI 0.56-0.64 for LOS ≥8 days).
Shorter length of index hospital stay is associated with earlier readmission and suggests that for this comorbid, older population, a shorter hospital stay may be detrimental. Readmission after 1 week is associated with increased chronic disease burden, suggesting they may be associated with factors that are less modifiable.
四分之一以上入住医院的医疗保险患者出院后被送往急性后护理（PAC）机构，但面临着较高的再入院率。再入院时间可能是识别未来再入院风险和可预防性的一个重要因素。本研究旨在确定与住院后出院至PAC机构第一周内再入院相关的因素。
这是对2011年加利福尼亚州、马萨诸塞州和佛罗里达州医疗保健成本与利用项目（HCUP）州住院数据库（SID）的二次分析。主要结局是65岁及以上从医院出院至PAC机构的患者在出院后7天内的全因再入院情况，与8-30天内的再入院情况进行比较。预测变量包括患者、首次住院和医院特征；采用多变量逻辑回归来识别7天内再入院的显著预测因素。
医院出院后前30天内有81173例来自PAC机构的医院再入院患者。第一周内再入院的患者年龄较大、为白人、居住在城市、合并症较少、既往住院次数较多，且较少以医疗保险作为支付方。首次住院时间越长，早期再入院风险越低（住院时间4-7天的OR为0.74；95%CI为0.70-0.74；住院时间≥8天的OR为0.60；95%CI为0.56-0.64）。
首次住院时间较短与较早再入院相关，这表明对于这个合并症多、年龄较大的人群，较短的住院时间可能有害。1周后再入院与慢性病负担增加相关，这表明它们可能与较难改变的因素有关。
