Shaaban Ahmed N, Dias Sara S, Muggli Zelia, Peleteiro Bárbara, Martins Maria Rosario O
Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisboa, Lisbon, Portugal.
EpiDoC Unit - CEDOC, NOVA Medical School - Universidade Nova de Lisboa (NMS-UNL), Lisbon, Portugal.
Front Public Health. 2020 Feb 21;8:15. doi: 10.3389/fpubh.2020.00015. eCollection 2020.
Thirty-day hospital readmission is receiving growing attention as an indicator of the quality of hospital care. Understanding factors associated with 30-day hospital readmission among HIV patients in Portugal is essential given the high burden cost of HIV hospitalizations in Portugal, a country suffering from financial constrains for almost 10 years. We aimed to estimate the 30-day hospital readmission rates among HIV patients in Portugal and to identify its determinants using population-based data for Portuguese public hospitals. A multilevel longitudinal population-based study. Between January 2009 and December 2014, a total of 37,134 registered discharges in the Portuguese National Health Service (NHS) facilities with HIV/AIDS as a main or secondary cause of admission were analyzed. Logistic regression was used to compare 30-day hospital readmission categories by computing odds ratio (OR) and corresponding 95% confidence intervals (95% CIs). A normal random effects model was used to determine unmeasured factors specific to each hospital. A total of 4914 (13.2%, 95% CI: 12.9%-13.6%) hospitalizations had a subsequent 30-day readmission. Hospitalizations that included exit against medical opinion (OR = 1.18, 95% CI: 1.01-1.39), scheduled admissions (OR = 1.71, 95% CI: 1.58-1.85), and tuberculosis infection (OR = 1.20, 95% CI: 1.05-1.38) exhibited a higher risk of hospitalizations with subsequent 30-day readmission. In contrast, hospitalizations that included females (OR = 0.87, 95% CI: 0.81-0.94), a transfer to another facility (OR = 0.78, 95% CI: 0.67-0.91), and having a responsible financial institution (OR = 0.63, 95% CI: 0.55-0.72) exhibited a lower risk of hospitalizations with subsequent 30-day readmission. Hospitalizations associated with higher number of diagnosis, older ages, or hospitalizations during the economic crisis showed an increasing trend of 30-day readmission, whereas an opposite trend was observed for hospitalizations with higher number of procedures. Significant differences exist between hospital quality, adjusting for other factors. This study analyzes the indicators of 30-day hospital readmission among HIV patients in Portugal and provides useful information for enlightening policymakers and health care providers for developing health policies that can reduce costs associated with HIV hospitalizations.
作为医院护理质量的一项指标，30天内再次入院正受到越来越多的关注。鉴于葡萄牙因艾滋病住院的高昂成本负担，该国已遭受近10年的财政限制，了解葡萄牙艾滋病毒患者30天内再次入院的相关因素至关重要。我们旨在估计葡萄牙艾滋病毒患者30天内再次入院率，并利用葡萄牙公立医院的基于人群的数据确定其决定因素。这是一项基于人群的多层次纵向研究。在2009年1月至2014年12月期间，对葡萄牙国家医疗服务体系（NHS）设施中以艾滋病毒/艾滋病作为主要或次要入院原因的37134例已登记出院病例进行了分析。采用逻辑回归通过计算比值比（OR）和相应的95%置信区间（95%CI）来比较30天内再次入院类别。使用正态随机效应模型来确定每家医院特有的未测量因素。共有4914例（13.2%，95%CI：12.9%-13.6%）住院病例随后在30天内再次入院。包括违反医疗意见出院（OR = 1.18，95%CI：1.01-1.39）、计划内入院（OR = 1.71，95%CI：1.58-1.85）和结核感染（OR = 1.20，95%CI：1.05-1.38）的住院病例随后30天内再次入院的风险较高。相比之下，包括女性（OR = 0.87，95%CI：0.81-0.94）、转至另一机构（OR = 0.78，95%CI：0.67-0.91）以及有责任金融机构（OR = 0.63，95%CI：0.55-0.72）的住院病例随后30天内再次入院的风险较低。与更多诊断、更高年龄或经济危机期间住院相关的住院病例30天内再次入院呈上升趋势，而手术数量较多的住院病例则呈现相反趋势。在调整其他因素后，医院质量之间存在显著差异。本研究分析了葡萄牙艾滋病毒患者30天内再次入院的指标，并为启发政策制定者和医疗服务提供者制定可降低与艾滋病毒住院相关成本的卫生政策提供了有用信息。
