Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.
Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
J Am Geriatr Soc. 2018 May;66(5):871-878. doi: 10.1111/jgs.15282. Epub 2018 Feb 20.
To assess the association between dementia and risk of hospital readmission and to evaluate whether the effect of dementia on hospital readmission varies according to primary diagnosis.
Retrospective cohort study.
Nationwide discharge database of acute care hospitals in Japan.
Individuals aged 65 and older diagnosed with one of the 30 most common diagnoses and discharged from 987 hospitals between April 2014 and September 2015 (N = 1,834,378).
The primary outcome was unplanned hospital readmission within 30 days. Poisson generalized estimating equation models were fitted to assess the risks of readmission for individuals with and without dementia, using primary diagnosis as a possible effect modifier and clinical factors as potential confounders.
The overall prevalence of dementia was 14.7% and varied according to primary diagnosis, ranging from 3.0% in individuals with prostate cancer to 69.4% in those with aspiration pneumonia. Overall, individuals with dementia had a higher risk of hospital readmission (8.3%) than those without (4.1%) (adjusted risk ratio (aRR])=1.46, 95% confidence interval (CI)=1.44-1.49), although diagnostic category substantially modified the relationship between dementia and hospital readmission. For hip fracture, dementia was associated with greater risk of hospital readmission (adjusted risk 11.5% vs 7.9%; aRR=1.46; 95% CI=1.28-1.68); this risk was attenuated for cholecystitis (adjusted risk 12.8% vs 12.4%; aRR=1.03; 95% CI=0.90-1.18).
Risk of hospital readmission associated with dementia varied according to primary diagnosis. Healthcare providers could enforce interventions to minimize readmission by focusing on comorbid conditions in individuals with dementia and specific primary diagnoses that increase their risk of readmission.
评估痴呆与住院再入院风险之间的关系，并评估痴呆对住院再入院的影响是否因主要诊断而异。
回顾性队列研究。
日本全国急性护理医院出院数据库。
2014 年 4 月至 2015 年 9 月期间，从 987 家医院诊断出 30 种最常见诊断之一并出院的年龄在 65 岁及以上的个人（N=1,834,378）。
主要结局是 30 天内计划外的医院再入院。使用初级诊断作为可能的效应修饰剂和临床因素作为潜在混杂因素，使用泊松广义估计方程模型评估有和没有痴呆的个体的再入院风险。
痴呆的总体患病率为 14.7%，根据主要诊断而有所不同，范围从前列腺癌患者的 3.0%到吸入性肺炎患者的 69.4%。总体而言，痴呆患者的住院再入院风险（8.3%）高于无痴呆患者（4.1%）（调整后的风险比（aRR）=1.46，95%置信区间（CI）=1.44-1.49），尽管诊断类别极大地改变了痴呆与住院再入院之间的关系。对于髋部骨折，痴呆与更高的住院再入院风险相关（调整后的风险为 11.5%比 7.9%；aRR=1.46；95%CI=1.28-1.68）；对于胆囊炎，这种风险降低（调整后的风险为 12.8%比 12.4%；aRR=1.03；95%CI=0.90-1.18）。
痴呆与住院再入院风险的相关性因主要诊断而异。医疗保健提供者可以通过专注于痴呆患者的合并症和增加其再入院风险的特定主要诊断，实施干预措施以尽量减少再入院。
