Dharmarajan Kumar, Qin Li, Bierlein Maggie, Choi Jennie E S, Lin Zhenqiu, Desai Nihar R, Spatz Erica S, Krumholz Harlan M, Venkatesh Arjun K
Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.
BMJ. 2017 Jun 20;357:j2616. doi: 10.1136/bmj.j2616.
To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays. Retrospective cohort study. 4750 hospitals in the USA. Nationally representative sample of Medicare fee for service beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11. Rates of emergency department treatment-and-discharge stays, observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from index observation stays. Rates were compared with corresponding outcomes within 30 days of discharge from both index emergency department treatment-and-discharge stays and index inpatient stays. Among 363 037 index observation stays resulting in discharge from 2006-11, 30 day rates of emergency department treatment-and-discharge stays were 8.4%, repeat observation stays were 2.9%, inpatient stays were 11.2%, any hospital revisit was 20.1%, and death was 1.8%. Of all revisits, 49.7% were for inpatient stays. Revisit rates for emergency department treatment-and-discharge stays, repeat observation stays, and any hospital revisit increased from 2006-11 (P<0.001 for trend), while 30 day rates of inpatient stays (P=0.054 for trend) and 30 day mortality (P=0.091 for trend) were both unchanged. Averaged over the study period, 30 day rates of any hospital revisit were similar after discharge from index emergency department treatment-and-discharge stays (19.9%) and index observation stays (20.1%), as was 30 day mortality (1.8% for both). Rates of any hospital revisit (21.8%) and death (5.2%) were highest after discharge from index inpatient stays. Hospital revisits are common after discharge from observation stays, frequently result in inpatient hospitalizations, and have increased over time among Medicare beneficiaries. As revisit rates are similar after emergency department and observation stays, strategies shown to enhance emergency department transitional care may be reasonable starting points to improve post-observation outcomes.
为了描述急诊科治疗并出院、重复观察住院、住院治疗、任何医院复诊以及观察住院出院后30天内死亡的发生率及随时间的变化趋势。回顾性队列研究。美国4750家医院。对2006 - 2011年期间363037次索引观察住院、2540000次索引急诊科治疗并出院以及2667525次索引住院治疗后出院的65岁及以上医疗保险按服务付费受益人的全国代表性样本进行研究。索引观察住院出院后30天内急诊科治疗并出院、观察住院、住院治疗、任何医院复诊以及死亡的发生率。将这些发生率与索引急诊科治疗并出院和索引住院治疗出院后30天内的相应结果进行比较。在2006 - 2011年导致出院的363037次索引观察住院中，30天内急诊科治疗并出院的发生率为8.4%，重复观察住院为2.9%，住院治疗为11.2%，任何医院复诊为20.1%，死亡为1.8%。在所有复诊中，49.7%是住院治疗。2006 - 2011年期间，急诊科治疗并出院、重复观察住院以及任何医院复诊的复诊率有所上升（趋势P<0.001），而30天内住院治疗发生率（趋势P = 0.054）和30天死亡率（趋势P = 0.091）均未改变。在研究期间平均来看，索引急诊科治疗并出院（19.9%）和索引观察住院（20.1%）出院后30天内任何医院复诊的发生率相似，30天死亡率也相似（均为1.8%）。索引住院治疗出院后30天内任何医院复诊的发生率（21.8%）和死亡率（5.2%）最高。观察住院出院后医院复诊很常见，经常导致住院治疗，并且在医疗保险受益人中随时间有所增加。由于急诊科和观察住院后的复诊率相似，已证明能加强急诊科过渡护理的策略可能是改善观察后结果的合理起点。
