Heppenstall Claire P, Chiang Anne, Hanger H Carl
Research Fellow, Department of Medicine, University of Otago, Christchurch.
Medical Student, University of Otago, Christchurch.
N Z Med J. 2018 Oct 26;131(1484):38-45.
To investigate frequency of and reasons for hospital readmission in a frail older cohort receiving a community-based, multidisciplinary, transitional care service.
A prospective cohort study with descriptive analysis of reasons for readmission in a cohort of frail older people discharged from hospital with the service. Measures of frailty, comorbidity, cognition, quality of life and function were recorded at discharge. Readmissions were recorded within three months after index discharge. Discharge summaries were reviewed and reasons for readmission categorised. Outcomes following readmission were recorded.
Readmission rates were high (42%) in our cohort, despite the intervention. People readmitted had worse functional ability and a greater burden of comorbidities. Half of the readmissions were classified as being new, acute medical problems requiring inpatient treatment, and a quarter as exacerbations of chronic medical problems. Eighty-six percent of those readmitted were able to return home following their readmission.
Our study showed high readmission rates despite the community supports. This high readmission rate does not imply failure of the intervention as the majority of these were with new or acute medical problems requiring inpatient treatment which were not preventable. Most were able to recover and return to their own homes.
调查接受社区多学科过渡性护理服务的体弱老年人群的医院再入院频率及原因。
一项前瞻性队列研究，对接受该服务出院的体弱老年人群队列的再入院原因进行描述性分析。出院时记录体弱、共病、认知、生活质量和功能的指标。在首次出院后的三个月内记录再入院情况。审查出院小结并对再入院原因进行分类。记录再入院后的结果。
尽管进行了干预，我们队列中的再入院率仍很高（42%）。再入院的人功能能力较差，共病负担较重。一半的再入院被归类为需要住院治疗的新的急性医疗问题，四分之一为慢性医疗问题的加重。86%的再入院患者在再入院后能够回家。
我们的研究表明，尽管有社区支持，再入院率仍很高。这种高再入院率并不意味着干预失败，因为其中大多数是需要住院治疗的新的或急性医疗问题，这些问题是无法预防的。大多数人能够康复并回到自己家中。
