Castillo Austin, Edriss Hawa, Selvan Kavitha, Nugent Kenneth
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock.
Qual Manag Health Care. 2017 Jul/Sep;26(3):152-159. doi: 10.1097/QMH.0000000000000143.
The Hospital Readmissions Reduction Program targets Medicare patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) and penalizes hospitals that have increased 30-day readmission rates for these patients. The main goals of this study were to determine the clinical explanations for readmissions within 30 days, to identify possible deficiencies in patient care, and to identify typical characteristics of patients who were readmitted to the hospital.
The medical records department at University Medical Center in Lubbock, Texas, generated a list of patients with a primary discharge diagnosis of either acute exacerbation of CHF or an acute exacerbation of COPD who were readmitted within 30 days of discharge. Data collected from the electronic medical records included demographic information, clinical information, laboratory data, electrocardiographic information, echocardiographic results, and radiographic information for the index admission and readmission hospitalization. The indication for readmission was determined after review of all clinical data.
The final study cohorts included 58 admission-readmission events for acute exacerbations of CHF (47 patients) and 27 admission-readmission events for acute exacerbations of COPD (16 patients). Patients in both cohorts had significant comorbidity and frequent admissions during the 12 months prior to their index admissions. Patients with COPD had predominantly an emphysematous phenotype. Chest radiographs in patients with CHF showed cardiomegaly, pulmonary edema, and pleural effusions. Patients with CHF were discharged with suboptimal medication regimens. Referral to outpatient rehabilitation programs was low in both groups.
Patients with acute exacerbations of COPD or CHF who require readmission within 30 days have complex comorbidity. They appear to have typical clinical profiles (emphysematous-type COPD patients and CHF patients with fluid overload), are frequently discharged with suboptimal medication regimens, and are not referred to outpatient rehabilitation. These patients had frequent hospitalizations prior to index hospitalizations. This information provides the basis for a focused review of patients admitted to the hospital to identify factors that might contribute to readmission.
医院再入院率降低计划针对患有充血性心力衰竭（CHF）和慢性阻塞性肺疾病（COPD）的医疗保险患者，并对这些患者30天再入院率增加的医院进行处罚。本研究的主要目的是确定30天内再入院的临床原因，识别患者护理中可能存在的不足，并确定再次入院患者的典型特征。
德克萨斯州拉伯克市大学医学中心的病历部门生成了一份在出院后30天内再次入院的患者名单，这些患者的主要出院诊断为CHF急性加重或COPD急性加重。从电子病历中收集的数据包括人口统计学信息、临床信息、实验室数据、心电图信息、超声心动图结果以及首次入院和再次入院时的影像学信息。在审查所有临床数据后确定再入院的指征。
最终的研究队列包括58例CHF急性加重的入院 - 再入院事件（47例患者）和27例COPD急性加重的入院 - 再入院事件（16例患者）。两个队列中的患者在首次入院前12个月内均有显著的合并症且频繁入院。COPD患者主要表现为肺气肿型。CHF患者的胸部X线片显示心脏扩大、肺水肿和胸腔积液。CHF患者出院时的药物治疗方案欠佳。两组患者转介至门诊康复项目的比例均较低。
需要在30天内再次入院的COPD或CHF急性加重患者合并症复杂。他们似乎具有典型的临床特征（肺气肿型COPD患者和液体超负荷的CHF患者），出院时药物治疗方案往往欠佳，且未被转介至门诊康复。这些患者在首次入院前频繁住院。这些信息为重点审查入院患者以确定可能导致再入院的因素提供了依据。
