H. James Free MD, Center for Primary Care Education & Innovation, Gainesville, FL, 32610, USA.
Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, 32603, USA.
J Gen Intern Med. 2020 Apr;35(4):1060-1068. doi: 10.1007/s11606-020-05643-2. Epub 2020 Jan 28.
Little is known about the frequency, patterns, and determinants of readmissions among patients initially hospitalized for an ambulatory care-sensitive condition (ACSC). The degree to which hospitalizations in close temporal proximity cluster has also not been studied. Readmission patterns involving clustering likely reflect different underlying determinants than the same number of readmissions more evenly spaced.
To characterize readmission rates, patterns, and predictors among patients initially hospitalized with an ACSC.
Retrospective analysis of the 2010-2014 Nationwide Readmissions Database.
Non-pregnant patients aged 18-64 years old during initial ACSC hospitalization and who were discharged alive (N = 5,007,820).
Frequency and pattern of 30-day all-cause readmissions, grouped as 0, 1, 2+ non-clustered, and 2+ clustered readmissions.
Approximately 14% of patients had 1 readmission, 2.4% had 2+ non-clustered readmissions, and 3.3% patients had 2+ clustered readmissions during the 270-day follow-up. A higher Elixhauser Comorbidity Index was associated with increased risk for all readmission groups, namely with adjusted odds ratios (AORs) ranging from 1.12 to 3.34. Compared to patients aged 80 years and older, those in younger age groups had increased risk of 2+ non-clustered and 2+ clustered readmissions (AOR range 1.27-2.49). Patients with chronic versus acute ACSCs had an increased odds ratio of all readmission groups compared to those with 0 readmissions (AOR range 1.37-2.69).
Among patients with 2+ 30-day readmissions, factors were differentially distributed between clustered and non-clustered readmissions. Identifying factors that could predict future readmission patterns can inform primary care in the prevention of readmissions following ACSC-related hospitalizations.
对于最初因门诊医疗敏感条件（ACSC）住院的患者，其再入院的频率、模式和决定因素知之甚少。在时间上接近的住院情况是否存在聚集也尚未得到研究。涉及聚集的再入院模式可能反映了不同的潜在决定因素，而不是相同数量的再入院更均匀地分布。
描述最初因 ACSC 住院的患者的再入院率、模式和预测因素。
对 2010-2014 年全国再入院数据库进行回顾性分析。
最初 ACSC 住院时年龄在 18-64 岁且存活出院的非孕妇患者（N=5007820）。
根据出院后 30 天内全因再入院的频率和模式进行分组，分为 0、1、2+无聚集和 2+聚集再入院。
在 270 天的随访期间，约 14%的患者有 1 次再入院，2.4%的患者有 2+无聚集再入院，3.3%的患者有 2+聚集再入院。较高的 Elixhauser 合并症指数与所有再入院组的风险增加相关，调整后的比值比（ORs）范围为 1.12 至 3.34。与 80 岁及以上的患者相比，年龄较轻的患者发生 2+无聚集和 2+聚集再入院的风险增加（OR 范围 1.27-2.49）。与 0 次再入院相比，患有慢性与急性 ACSC 的患者所有再入院组的 OR 均增加（OR 范围 1.37-2.69）。
在有 2+30 天再入院的患者中，聚集性和非聚集性再入院之间的因素分布不同。确定可预测未来再入院模式的因素可以为 ACSC 相关住院后的预防再入院提供初级保健信息。
