Ohnuma Tetsu, Shinjo Daisuke, Brookhart Alan M, Fushimi Kiyohide
1Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519 Japan.
2Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
J Intensive Care. 2018 Mar 1;6:14. doi: 10.1186/s40560-018-0284-x. eCollection 2018.
Reducing the 30-day unplanned hospital readmission rate is a goal for physicians and policymakers in order to improve quality of care. However, data on the readmission rate of critically ill patients in Japan and knowledge of the predictors associated with readmission are lacking. We investigated predictors associated with 30-day rehospitalization for medical and surgical adult patients separately.
Patient data from 502 acute care hospitals with intensive care unit (ICU) facilities in Japan were retrospectively extracted from the Japanese Diagnosis Procedure Combination (DPC) database between April 2012 and February 2014. Factors associated with unplanned hospital readmission within 30 days of hospital discharge among medical and surgical ICU survivors were identified using multivariable logistic regression analysis.
Of 486,651 ICU survivors, we identified 5583 unplanned hospital readmissions within 30 days of discharge following 147,423 medical hospitalizations (3.8% readmitted) and 11,142 unplanned readmissions after 339,228 surgical hospitalizations (3.3% readmitted). The majority of unplanned hospital readmissions, 60.9% of medical and 63.1% of surgical case readmissions, occurred within 15 days of discharge. For both medical and surgical patients, the Charlson comorbidity index score; category of primary diagnosis during the index admission (respiratory, gastrointestinal, and metabolic and renal); hospital length of stay; discharge to skilled nursing facilities; and having received a packed red blood cell transfusion, low-dose steroids, or renal replacement therapy were significantly associated with higher unplanned hospital readmission rates.
From patient data extracted from a large Japanese national database, the 30-day unplanned hospital readmission rate after ICU stay was 3.4%. Further studies are required to improve readmission prediction models and to develop targeted interventions for high-risk patients.
降低30天非计划住院再入院率是医生和政策制定者提高医疗质量的目标。然而，日本重症患者再入院率的数据以及与再入院相关的预测因素尚不清楚。我们分别调查了内科和外科成年患者30天再住院的预测因素。
回顾性提取2012年4月至2014年2月间日本502家设有重症监护病房（ICU）的急性护理医院的患者数据，这些数据来自日本诊断程序组合（DPC）数据库。使用多变量逻辑回归分析确定内科和外科ICU幸存者在出院后30天内非计划住院再入院的相关因素。
在486,651名ICU幸存者中，我们确定了147,423例内科住院后30天内有5583例非计划住院再入院（再入院率3.8%），以及339,228例外科住院后有11,142例非计划再入院（再入院率3.3%）。大多数非计划住院再入院发生在出院后15天内，内科病例为60.9%，外科病例为63.1%。对于内科和外科患者，查尔森合并症指数评分、首次入院时的主要诊断类别（呼吸、胃肠、代谢和肾脏）、住院时间、出院至专业护理机构以及接受过浓缩红细胞输血、低剂量类固醇或肾脏替代治疗均与较高的非计划住院再入院率显著相关。
从一个大型日本国家数据库提取的患者数据来看，ICU住院后30天非计划住院再入院率为3.4%。需要进一步研究以改进再入院预测模型，并为高危患者制定有针对性的干预措施。
