Department of Family Medicine (Gruneir), University of Alberta, Edmonton, Alta.; ICES (Gruneir, Fung, Fischer, Bronskill, Bell, Rochon, Anderson); Women's College Research Institute (Gruneir, Bronskill, Panjwani, Rochon), Women's College Hospital; Institute of Health Policy, Management and Evaluation (Bronskill, Bell, Dhalla, Rochon, Anderson) and Department of Medicine (Dhalla), University of Toronto; Department of Medicine (Bell, Dhalla), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Health Quality Ontario (Dhalla), Toronto, Ont.
CMAJ. 2018 Sep 24;190(38):E1124-E1133. doi: 10.1503/cmaj.180290.
Despite the fact that many older adults receive home or long-term care services, the effect of these care settings on hospital readmission is often overlooked. Efforts to reduce hospital readmissions, including capacity planning and targeting of interventions, require clear data on the frequency of and risk factors for readmission among different populations of older adults.
We identified all adults older than 65 years discharged from an unplanned medical hospital stay in Ontario between April 2008 and December 2015. We defined 2 preadmission care settings (community, long-term care) and 3 discharge care settings (community, home care, long-term care) and used multinomial regression to estimate associations with 30-day readmission (and death as a competing risk).
We identified 701 527 individuals (mean age 78.4 yr), of whom 414 302 (59.1%) started in and returned to the community. Overall, 88 305 in dividuals (12.6%) were re admitted within 30 days, but this proportion varied by care setting combination. Relative to individuals returning to the community, those discharged to the community with home care (adjusted odds ratio [OR] 1.43, 95% confidence interval [CI] 1.39-1.46) and those returning to long-term care (adjusted OR 1.35, 95% CI 1.27-1.43) had a greater risk of readmission, whereas those newly admitted to long-term care had a lower risk of readmission (adjusted OR 0.68, 95% CI 0.63-0.72).
In Ontario, about 40% of older people were discharged from hospital to either home care or long-term care. These discharge settings, as well as whether an individual was admitted to hospital from long-term care, have important implications for understanding 30-day readmission rates. System planning and efforts to reduce readmission among older adults should take into account care settings at both admission and discharge.
尽管许多老年人接受家庭或长期护理服务，但这些护理环境对住院再入院的影响往往被忽视。为了降低住院再入院率，包括进行能力规划和有针对性地采取干预措施，需要明确不同老年人群体的再入院频率和风险因素的数据。
我们确定了 2008 年 4 月至 2015 年 12 月期间在安大略省因非计划性医疗住院而出院的所有年龄在 65 岁以上的成年人。我们定义了 2 种入院前护理环境（社区、长期护理）和 3 种出院护理环境（社区、家庭护理、长期护理），并使用多项回归来估计与 30 天再入院（以死亡为竞争风险）相关的关联。
我们确定了 701527 人（平均年龄 78.4 岁），其中 414302 人（59.1%）从社区开始并返回社区。总体而言，88305 人（12.6%）在 30 天内再次入院，但这一比例因护理环境组合而异。与返回社区的人相比，那些被转到社区并接受家庭护理的人（调整后的优势比[OR]1.43，95%置信区间[CI]1.39-1.46）和返回长期护理的人（调整后的 OR 1.35，95%CI 1.27-1.43）再入院的风险更高，而那些新入院长期护理的人再入院的风险较低（调整后的 OR 0.68，95%CI 0.63-0.72）。
在安大略省，约有 40%的老年人从医院出院后被转到家庭护理或长期护理。这些出院环境，以及个人是否从长期护理中被重新入院，对了解 30 天再入院率具有重要意义。系统规划和努力降低老年人的再入院率应考虑入院和出院时的护理环境。
