谁的观察护理住院经历不成功？

Who Has an Unsuccessful Observation Care Stay?

作者信息

Gabayan Gelareh Z, Doyle Brian, Liang Li-Jung, Donkor Kwame, Huang David Yu-Chuang, Sarkisian Catherine A

机构信息

Department of Emergency Medicine, University of California, Los Angeles, CA 90024, USA.

Department of Internal Medicine, Ohio State University, Columbus, OH 43210, USA.

出版信息

Healthcare (Basel). 2018 Nov 27;6(4):138. doi: 10.3390/healthcare6040138.

DOI:10.3390/healthcare6040138

PMID:30486381

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6316509/

Abstract

BACKGROUND

With the recent increase use of observation care, it is important to understand the characteristics of patients that utilize this care and either have a prolonged observation care stay or require admission.

METHODS

We a conducted a retrospective cohort study utilizing 5% sample data from Medicare patients age ≥65 years that was nationally representative in the year 2013. We performed a generalized estimating equation (GEE) logistic regression analysis to evaluate the relationship between an unsuccessful observation stay (defined as either requiring an inpatient admission from observation or having a prolonged observation stay) compared to having successful observation care. Observation cut offs of "successful" vs. "unsuccessful" were based on the CMS 2 midnight rule.

RESULTS

Of 154,756 observation stays in 2013, 19 percent (n = 29,604) were admitted to the inpatient service and 34,275 (22.2%) had a prolonged observation stay. The two diagnoses most likely to have an unsuccessful observation stay were intestinal infections (OR 1.56, 95% CI 1.32⁻1.83) and pneumonia (OR 1.26, 95% CI 1.13⁻1.41).

CONCLUSION

We found patients placed in observation care with intestinal infections and pneumonia to have the highest odds of either being admitted from observation or having a prolonged observation stay.

摘要

背景

随着近期观察护理使用的增加，了解使用这种护理且观察护理住院时间延长或需要住院治疗的患者特征非常重要。

方法

我们利用2013年具有全国代表性的医疗保险65岁及以上患者5%的抽样数据进行了一项回顾性队列研究。我们进行了广义估计方程（GEE）逻辑回归分析，以评估与成功的观察护理相比，不成功的观察住院（定义为从观察转为住院或观察住院时间延长）之间的关系。“成功”与“不成功”的观察截止点基于医疗保险和医疗补助服务中心（CMS）的午夜规则。

结果

2013年的154,756次观察住院中，19%（n = 29,604）被收治到住院服务科室，34,275次（22.2%）观察住院时间延长。最有可能观察住院不成功的两种诊断是肠道感染（比值比[OR] 1.56，95%置信区间[CI] 1.32 - 1.83）和肺炎（OR 1.26，95% CI 1.13 - 1.41）。