专科后续护理如何影响老年代谢、心脏和慢性阻塞性肺疾病患者的长期再入院风险：使用行政数据的队列研究

How Specialist Aftercare Impacts Long-Term Readmission Risks in Elderly Patients With Metabolic, Cardiac, and Chronic Obstructive Pulmonary Diseases: Cohort Study Using Administrative Data.

作者信息

Kaleta Michaela, Niederkrotenthaler Thomas, Kautzky-Willer Alexandra, Klimek Peter

机构信息

Section for Science of Complex Systems, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.

Complexity Science Hub Vienna, Vienna, Austria.

出版信息

JMIR Med Inform. 2020 Sep 16;8(9):e18147. doi: 10.2196/18147.

DOI:10.2196/18147

PMID:32936077

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7527915/

Abstract

BACKGROUND

The health state of elderly patients is typically characterized by multiple co-occurring diseases requiring the involvement of several types of health care providers.

OBJECTIVE

We aimed to quantify the benefit for multimorbid patients from seeking specialist care in terms of long-term readmission risks.

METHODS

From an administrative database, we identified 225,238 elderly patients with 97 different diagnosis (ICD-10 codes) from hospital stays and contact with 13 medical specialties. For each diagnosis associated with the first hospital stay, we used multiple logistic regression analysis to quantify the sex-specific and age-adjusted long-term all-cause readmission risk (hospitalizations occurring between 3 months and 3 years after the first admission) and how specialist contact impacts these risks.

RESULTS

Men have a higher readmission risk than women (mean difference over all first diagnoses 1.9%, P<.001), but similar reduction in readmission risk after receiving specialist care. Specialist care can reduce readmission risk by almost 50%. We found the greatest reductions in risk when the first hospital stay was associated with diagnoses corresponding to complex chronic diseases such as acute myocardial infarction (57.6% reduction in readmission risk, SE 7.6% for men [m]; 55.9% reduction, SE 9.8% for women [w]), diabetic and other retinopathies (m: 62.3%, SE 8.0; w: 60.1%, SE 8.4%), chronic obstructive pulmonary disease (m: 63.9%, SE 7.8%; w: 58.1%, SE 7.5%), disorders of lipoprotein metabolism (m: 64.7%, SE 3.7%; w: 63.8%, SE 4.0%), and chronic ischemic heart diseases (m: 63.6%, SE 3.1%; w: 65.4%, SE 3.0%).

CONCLUSIONS

Specialist care can greatly reduce long-term readmission risk for patients with chronic and multimorbid diseases. Further research is needed to identify the specific reasons for these findings and to understand the detected sex-specific differences.

摘要

背景

老年患者的健康状况通常表现为多种疾病并存，需要多种类型的医疗保健提供者参与。

目的

我们旨在根据长期再入院风险，量化多病共存患者寻求专科护理的益处。

方法

从一个行政数据库中，我们识别出225238名老年患者，他们因住院和与13个医学专科接触而有97种不同诊断（ICD - 10编码）。对于与首次住院相关的每种诊断，我们使用多元逻辑回归分析来量化性别特异性和年龄调整后的长期全因再入院风险（首次入院后3个月至3年期间发生的住院）以及专科接触如何影响这些风险。

结果

男性的再入院风险高于女性（所有首次诊断的平均差异为1.9%，P <.001），但接受专科护理后再入院风险的降低幅度相似。专科护理可将再入院风险降低近50%。当首次住院与复杂慢性病的诊断相关时，我们发现风险降低幅度最大，如急性心肌梗死（男性再入院风险降低57.6%，标准误7.6%[m]；女性降低55.9%；标准误9.8%[w]）、糖尿病及其他视网膜病变（m：62.3%，标准误8.0；w：60.1%，标准误8.4%）、慢性阻塞性肺疾病（m：63.9%，标准误7.8%；w：58.1%，标准误7.5%）、脂蛋白代谢紊乱（m：64.7%，标准误3.7%；w：63.8%，标准误4.0%）以及慢性缺血性心脏病（m：63.6%，标准误3.1%；w：65.4%，标准误3.0%）。