Shebehe Jacques, Hansson Anders
a The University Healthcare Research Centre, Faculty of Medicine and Health , Örebro University , Örebro , Sweden.
b Academy of Sahlgrenska, Institute of Medicine , University of Gothenburg , Gothenburg , Sweden.
Scand J Prim Health Care. 2018 Sep;36(3):300-307. doi: 10.1080/02813432.2018.1499584. Epub 2018 Aug 23.
There is a presumption that hospital readmission rates amongst persons aged ≥65 years are mainly dependent on the quality of care. In this study, our primary aim was to explore the association between 30-day hospital readmission for patients aged ≥65 years and socioeconomic characteristics of the studied population. A secondary aim was to explore the association between self-reported lack of strategies for working with older patients at primary health care centres and early readmission.
A cross-sectional ecological study and an online questionnaire sent to the heads of the primary health care centres. We performed correlation and regression analyses.
Register data of 283,063 patients in 29 primary health care centres in the Region Örebro County (Sweden) in 2014.
Thirty-day hospital readmission rates for patients aged ≥65 years. Covariates were socioeconomic characteristics among patients registered at the primary health care centre and eldercare workload.
Early hospital readmission was found to be associated with low socioeconomic status of the studied population: proportion foreign-born (r = 0.74; p < 0.001), proportion unemployed (r = 0.73; p < 0.001), Care Need Index (r = 0.74; p < 0.001), sick leave rate (r = 0.51; p < 0.01) and average income (r = -0.40; p = 0.03). The proportion of unemployed alone could explain up to 71.4% of the variability in hospital readmission (p < 0.001). Primary health care centres reporting lack of strategies to prevent readmissions in older patients did not have higher hospital readmission rates than those reporting they had such strategies.
Primary health care centres localized in neighbourhoods with low socioeconomic status had higher rates of hospital readmission for patients aged ≥65. Interventions aimed at reducing hospital readmissions for older patients should also consider socioeconomic disparities. Key Points In Sweden, hospital readmission within 30 days among patients aged ≥65 has been used as a measure of quality of primary care for the elderly. However, in our study, elderly 30-day readmission was associated with low neighbourhood socioeconomic status. A simple survey in one Swedish region showed that the primary health care centres that lacked active strategies for working with aged patients did not have higher hospital readmission rates than those that reported having strategies. Interventions aimed at reducing elderly hospital readmissions should therefore also consider the socioeconomic disparities in the elderly.
有一种假设认为，65岁及以上人群的医院再入院率主要取决于医疗质量。在本研究中，我们的主要目的是探讨65岁及以上患者30天医院再入院与研究人群社会经济特征之间的关联。次要目的是探讨初级卫生保健中心自我报告的缺乏针对老年患者的工作策略与早期再入院之间的关联。
一项横断面生态研究，并向初级卫生保健中心负责人发送在线问卷。我们进行了相关性和回归分析。
2014年瑞典厄勒布鲁县29个初级卫生保健中心的283,063名患者的登记数据。
65岁及以上患者的30天医院再入院率。协变量为在初级卫生保健中心登记的患者的社会经济特征和老年护理工作量。
发现早期医院再入院与研究人群的低社会经济地位相关：外国出生比例（r = 0.74；p < 0.001）、失业比例（r = 0.73；p < 0.001）、护理需求指数（r = 0.74；p < 0.001）、病假率（r = 0.51；p < 0.01）和平均收入（r = -0.40；p = 0.03）。仅失业比例就能解释医院再入院变异性的高达71.4%（p < 0.001）。报告缺乏预防老年患者再入院策略的初级卫生保健中心的医院再入院率并不高于报告有此类策略的中心。
位于社会经济地位较低社区的初级卫生保健中心，65岁及以上患者的医院再入院率较高。旨在降低老年患者医院再入院率的干预措施也应考虑社会经济差异。要点 在瑞典，65岁及以上患者30天内的医院再入院已被用作衡量老年人初级保健质量的指标。然而，在我们的研究中，老年患者30天再入院与社区低社会经济地位相关。瑞典一个地区的一项简单调查显示，缺乏针对老年患者积极工作策略的初级卫生保健中心的医院再入院率并不高于报告有策略的中心。因此，旨在降低老年患者医院再入院率的干预措施也应考虑老年人中的社会经济差异。
