创伤后全国范围内非选择性再入院的风险因素及相关费用。
Risk factors and costs associated with nationwide nonelective readmission after trauma.
作者信息
Parreco Joshua, Buicko Jessica, Cortolillo Nicholas, Namias Nicholas, Rattan Rishi
机构信息
From the Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
出版信息
J Trauma Acute Care Surg. 2017 Jul;83(1):126-134. doi: 10.1097/TA.0000000000001505.
BACKGROUND
Most prior studies of readmission after trauma have been limited to single institutions, whereas multi-institutional studies have been limited to single states and an inability to distinguish between elective and nonelective readmissions. The purpose of this study was to identify the risk factors and costs associated with nonelective readmission after trauma across the United States.
METHODS
The Nationwide Readmission Database was queried for all patients with nonelective admissions in 2013 and 2014 with a primary diagnosis of trauma. Univariate and multivariate logistic regression identified risk factors for 30-day nonelective same- and different-hospital readmission. The diagnosis groups on readmission were evaluated, and the total cost of readmissions was calculated.
RESULTS
There were 1,180,144 patients admitted for trauma, the 30-day readmission rate was 9.4%, and 26.4% of readmissions occurred at a different hospital. The median readmission cost for patients readmitted to the same hospital was $8,298 (interquartile range, $4,899-$14,911), whereas the median readmission cost for patients readmitted to a different hospital was $8,568 (interquartile range, $4,935-$16,078; p < 0.01). Multivariate regression revealed that patients discharged against medical advice were at increased risk of readmission (odds ratio, 2.79; p < 0.01) and readmission to a different facility (odds ratio, 1.58; p < 0.01). Home health care was associated with a decreased risk of readmission to a different hospital (odds ratio, 0.74; p < 0.01). Septicemia and disseminated infections were the most common diagnoses on readmission (8.4%) and readmission to a different hospital (8.6%).
CONCLUSIONS
A significant portion of US readmissions occur at different hospitals with implications for continuity of care, quality metrics, cost, and resource allocation. Home health care reduces the likelihood of nonelective readmission to a different hospital. Infection was the most common reason for readmission, with ramifications for outcomes research and quality improvement.
LEVEL OF EVIDENCE
Care management/epidimeological, level IV.
背景
大多数先前关于创伤后再入院的研究仅限于单一机构，而多机构研究则局限于单个州，并且无法区分选择性和非选择性再入院。本研究的目的是确定全美国创伤后非选择性再入院的风险因素及相关费用。
方法
查询全国再入院数据库，获取2013年和2014年所有非选择性入院且主要诊断为创伤的患者信息。单因素和多因素逻辑回归分析确定30天非选择性同院和异院再入院的风险因素。评估再入院时的诊断分组，并计算再入院的总费用。
结果
共有1,180,144例因创伤入院的患者，30天再入院率为9.4%，26.4%的再入院发生在不同医院。同院再入院患者的再入院费用中位数为8,298美元（四分位间距，4,899 - 14,911美元），而异院再入院患者的再入院费用中位数为8,568美元（四分位间距，4,935 - 16,078美元；p < 0.01）。多因素回归分析显示，违反医嘱出院的患者再入院风险增加（比值比，2.79；p < 0.01）以及转至不同医疗机构再入院的风险增加（比值比，1.58；p < 0.01）。接受家庭医疗护理与异院再入院风险降低相关（比值比，0.74；p < 0.01）。败血症和播散性感染是再入院（8.4%）及异院再入院（8.6%）时最常见的诊断。
结论
美国相当一部分再入院发生在不同医院，这对医疗连续性、质量指标、费用及资源分配均有影响。家庭医疗护理可降低非选择性异院再入院的可能性。感染是再入院最常见的原因，对结局研究和质量改进有影响。
证据水平
护理管理/流行病学，四级。
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