德国养老院患者的潜在可避免住院治疗？利用模式及其对医疗保健的潜在影响的横断面研究。
Potentially avoidable hospitalisations of German nursing home patients? A cross-sectional study on utilisation patterns and potential consequences for healthcare.
机构信息
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
出版信息
BMJ Open. 2019 Jan 21;9(1):e025269. doi: 10.1136/bmjopen-2018-025269.
OBJECTIVES
Demand for nursing home (NH) care is soaring due to gains in life expectancy and people living longer with chronic illness and disability. This is dovetailing with workforce shortages across the healthcare profession. Access to timely and appropriate medical care for NH residents is becoming increasingly challenging and can result in potentially avoidable hospitalisations (PAHs). In light of these factors, we analysed PAHs comparing NH patients with non-NH patients.
DESIGN
Cross-sectional study with claims data from 2015 supplied by a large German health insurance company within the federal state of Baden-Wuerttemberg.
SETTING
One-year observation of hospitalisation patterns for NH and non-NH patients.
PARTICIPANTS
3 872 245 of the 10.5million inhabitants of Baden-Wuerttemberg were covered.
METHODS
Patient data about hospitalisation date, sex, age, nationality, level of care and diagnoses were available. PAHs were defined based on international classification of diseases (ICD-10) diagnoses belonging to ambulatory care sensitive conditions (ACSCs). Adjusted ORs for PAHs for NH patients in comparison with non-NH patients were calculated with multivariable regression models.
RESULTS
Of the 933 242 hospitalisations in 2015, there were 23 982 for 13 478 NH patients and 909 260 for 560 998 non-NH patients. Mean age of hospitalised NH patients and level of care were significantly higher than those of non-NH patients. 6449 PAHs (29.6%) for NH patients and 136 543 PAHs (15.02%) for non-NH patients were identified. The adjusted OR for PAHs was significantly heightened for NH patients in comparison with non-NH patients (OR: 1.22, CI (1.18 to 1.26), p<0.0001). Moreover, we could observe that more than 90% of PAHs with ACSCs were unplanned hospitalisations (UHs).
CONCLUSIONS
Large numbers of PAHs for NH patients calls for improved coordination of medical care, especially general practitioner service provision. Introduction of targeted training programmes for physicians and NH staff on health problem management for NH patients could perhaps contribute to reduction of PAHs, predominantly UHs.
目的
由于预期寿命的延长以及慢性病和残疾患者的寿命延长，对疗养院（NH）护理的需求猛增。这与整个医疗保健行业的劳动力短缺相吻合。NH 居民获得及时和适当的医疗服务正变得越来越具有挑战性，并可能导致潜在可避免的住院治疗（PAH）。鉴于这些因素，我们分析了 NH 患者与非 NH 患者相比的 PAH。
设计
横断面研究，使用来自德国巴登-符腾堡州大型医疗保险公司的 2015 年索赔数据。
设置
NH 和非 NH 患者住院模式的一年观察。
参与者
巴登-符腾堡州的 1050 万居民中有 387.245 人受到保障。
方法
患者数据包括住院日期、性别、年龄、国籍、护理水平和诊断。根据属于门诊护理敏感条件（ACSC）的国际疾病分类（ICD-10）诊断，定义了 PAH。使用多变量回归模型计算与非 NH 患者相比 NH 患者的 PAH 的调整后 OR。
结果
在 2015 年的 933242 例住院治疗中，23982 例是 13478 名 NH 患者，909260 例是 560998 名非 NH 患者。住院 NH 患者的平均年龄和护理水平明显高于非 NH 患者。在 NH 患者中发现了 6449 例（29.6%）PAH 和非 NH 患者中 136543 例（15.02%）PAH。与非 NH 患者相比，NH 患者的 PAH 调整后 OR 显著升高（OR：1.22，CI（1.18 至 1.26），p<0.0001）。此外，我们可以观察到，超过 90%的 ACSC 相关 PAH 是计划外住院（UH）。
结论
NH 患者大量的 PAH 需要改善医疗服务的协调，特别是全科医生服务的提供。为 NH 患者的健康问题管理为医生和 NH 工作人员引入有针对性的培训计划，或许可以有助于减少 PAH，主要是 UH。
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