Shaw Jawaid A, Ali Asghar, Qaiser Rabia, Layman Erynn, Fagan Cynthia, Schwartz Owen, Sima Adam, Hazelrigg Monica
Internal Medicine, Virginia Commonwealth University, Richmond, USA.
Internal Medicine/Hospital Medicine, Hunter Holmes McGuire VA Medical Center/Virginia Commonwealth University, Richmond, USA.
Cureus. 2020 Jun 9;12(6):e8529. doi: 10.7759/cureus.8529.
Introduction There is a paucity of comparative data on readmissions between teaching services (TS) and nonteaching services (NTS). Therefore, we designed this study to determine if there are any differences in readmissions between the two services. Materials and methods A unique cohort of 384 readmissions during one year was retrospectively examined at Hunter Holmes McGuire Veterans Medical Center. The data on patient demographics, baseline characteristics, comorbid illnesses, length of stay (LOS), and reasons for readmission within 30 days were extracted. Results There were no differences in readmission rates (8.2% vs. 10.2%; P = .135), LOS during index admission (4.2 ± 4.8 vs. 4.1 ± 3.5; P = .712), and age-adjusted Charlson Comorbid Index Score (6.1 ± 3.0 vs. 6.8 ± 2.8; P = .037) between the TS and NTS groups. However, the reasons for readmissions between the two groups were statistically significantly different (P < .01). Specifically, these differences were found between system issues and new diagnoses. The NTS showed higher rates of readmissions secondary to new diagnoses and systems issues, whereas the TS showed higher rates of secondary to clinician issues and disease progression. Conclusions We have a new understanding of the difference in reasons for readmissions between TS and NTS; it possibly results from the different structures of the two teams, which may help us address readmissions in a different light to improve overall readmission rate.
关于教学服务(TS)和非教学服务(NTS)再入院情况的比较数据较少。因此,我们设计了本研究以确定这两种服务在再入院方面是否存在差异。
在亨特·霍姆斯·麦圭尔退伍军人医疗中心对一组独特的384例一年内的再入院病例进行了回顾性研究。提取了患者人口统计学、基线特征、合并疾病、住院时间(LOS)以及30天内再入院原因的数据。
TS组和NTS组在再入院率(8.2%对10.2%;P = 0.135)、首次入院期间的住院时间(4.2±4.8对4.1±3.5;P = 0.712)以及年龄调整后的查尔森合并症指数评分(6.1±3.0对6.8±2.8;P = 0.037)方面没有差异。然而,两组之间的再入院原因在统计学上有显著差异(P < 0.01)。具体而言,这些差异存在于系统问题和新诊断之间。NTS组因新诊断和系统问题导致的再入院率较高,而TS组因临床医生问题和疾病进展导致的再入院率较高。
我们对TS和NTS再入院原因的差异有了新的认识;这可能是由于两个团队的结构不同,这可能有助于我们从不同角度解决再入院问题,以提高总体再入院率。