Veeranki Sreenivas P, Ohabughiro Michael U, Moran Jacob, Mehta Hemalkumar B, Ameredes Bill T, Kuo Yong-Fang, Calhoun William J
a Department of Preventive Medicine and Community Health , University of Texas Medical Branch , Galveston , TX , USA.
b School of Medicine , University of Texas Medical Branch , Galveston , TX , USA.
J Asthma. 2018 Jul;55(7):695-704. doi: 10.1080/02770903.2017.1365888. Epub 2017 Oct 13.
Previous single-center studies have reported that up to 40% of children hospitalized for asthma will be readmitted. The study objectives are to investigate the prevalence and timing of 30-day readmissions in children hospitalized with asthma, and to identify factors associated with 30-day readmissions.
Data (n = 12,842) for children aged 6-18 years hospitalized for asthma were obtained from the 2013 Nationwide Readmission Database (NRD). The primary study outcome was time to readmission within 30 days after discharge attributable to any cause. Several predictors associated with the risk of admission were included: patient (age, sex, median household income, insurance type, county location, and pediatric chronic complex condition), admission (type, day, emergency services utilization, length of stay (LOS), and discharge disposition), and hospital (ownership, bed size, and teaching status). Cox's proportional hazards model was used to identify predictors.
Of 12,842 asthma-related index hospitalizations, 2.5% were readmitted within 30-days post-discharge. Time to event models identified significantly higher risk of readmission among asthmatic children aged 12-18 years, those who resided in micropolitan counties, those with >4-days LOS during index hospitalization, those who were hospitalized in an urban hospital, who had unfavorable discharge (hazard ratio 2.53, 95% confidence interval 1.33-4.79), and those who were diagnosed with a pediatric complex chronic condition, respectively, than children in respective referent categories.
A multi-dimensional approach including effective asthma discharge action plans and follow-up processes, home-based asthma education, and neighborhood/community-level efforts to address disparities should be integrated into the routine clinical care of asthma children.
以往的单中心研究报告称，因哮喘住院的儿童中高达40%会再次入院。本研究的目的是调查哮喘住院儿童30天再入院的患病率和时间，并确定与30天再入院相关的因素。
从2013年全国再入院数据库（NRD）中获取6至18岁因哮喘住院儿童的数据（n = 12842）。主要研究结果是出院后30天内因任何原因再次入院的时间。纳入了几个与入院风险相关的预测因素：患者（年龄、性别、家庭收入中位数、保险类型、县位置和儿科慢性复杂疾病）、入院（类型、日期、急诊服务使用情况、住院时间（LOS）和出院处置）以及医院（所有权、床位规模和教学状态）。使用Cox比例风险模型来确定预测因素。
在12842例与哮喘相关的首次住院病例中，2.5%在出院后30天内再次入院。事件时间模型确定，12至18岁的哮喘儿童、居住在微型都市县的儿童、首次住院期间住院时间>4天的儿童、在城市医院住院的儿童、出院情况不佳的儿童（风险比2.53，95%置信区间1.33 - 4.79）以及被诊断患有儿科复杂慢性病的儿童，与各自参照类别中的儿童相比，再次入院的风险显著更高。
应将包括有效的哮喘出院行动计划和随访流程、家庭哮喘教育以及解决差异的邻里/社区层面努力在内的多维度方法纳入哮喘儿童的常规临床护理中。
