Department of Emergency Medicine, Massachusetts General Hospital.
Harvard Medical School, Boston, MA.
Med Care. 2018 Aug;56(8):673-678. doi: 10.1097/MLR.0000000000000940.
To investigate the longitudinal changes in principal readmission diagnoses within 30 days after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Medicare claims data, 2010-2012.
Retrospective cohort study.
We identified AECOPD hospitalizations aged 65 years and above, and examined the principal 30-day readmission diagnoses (respiratory related, cardiac related, and other conditions). We also constructed Joinpoint regression models to test whether patients with each of the 3 major readmission conditions had a unique temporal pattern of readmission during the 30-day period.
Among 76,697 index hospitalizations with AECOPD, 14,090 (18.4%) were readmitted within 30 days. Respiratory-related conditions accounted for 55% of readmissions. The proportion of respiratory-related conditions as the readmission diagnosis decreased from postdischarge day 1 to day 8 (4.0% decrease), and then increased thereafter (13.2% increase; P=0.06). Cardiac-related conditions had a similar nonlinear trend with an inflection point at day 6 (P=0.02), with a subsequent downward trend from day 22 (P=0.01). By contrast, the other conditions increased from day 1 to day 6 (15.0% increase), and then significantly decreased (28.8% decrease; P=0.04).
The proportions of principal discharge diagnosis of readmission changed significantly at around postdischarge day 7. Our findings advance research into identification of the underlying mechanisms and development of targeted interventions to prevent readmissions.
调查慢性阻塞性肺疾病急性加重（AECOPD）住院后 30 天内主要再入院诊断的纵向变化。
医疗保险索赔数据，2010-2012 年。
回顾性队列研究。
我们确定了年龄在 65 岁及以上的 AECOPD 住院患者，并检查了主要的 30 天再入院诊断（与呼吸相关、与心脏相关和其他情况）。我们还构建了 Joinpoint 回归模型，以测试具有 3 种主要再入院情况的患者在 30 天期间是否具有独特的再入院时间模式。
在 76697 例 AECOPD 指数住院中，有 14090 例（18.4%）在 30 天内再次入院。与呼吸相关的情况占再入院的 55%。出院后第 1 天至第 8 天，与呼吸相关的情况作为再入院诊断的比例下降（下降 4.0%），此后再增加（增加 13.2%；P=0.06）。与心脏相关的情况呈类似的非线性趋势，拐点在第 6 天（P=0.02），此后呈下降趋势（第 22 天，P=0.01）。相比之下，其他情况从第 1 天到第 6 天增加（增加 15.0%），然后显著减少（减少 28.8%；P=0.04）。
出院后第 7 天左右，主要出院诊断的比例发生了显著变化。我们的研究结果推进了对识别潜在机制和开发有针对性的干预措施以预防再入院的研究。
