Keyes Daniel, Sheremeta Greg, Yang Jerrit, Davis Naomi, Zhang Shiling, Boehm Kevin
St Mary Mercy Hospital Emergency Medicine and Graduate Medical Education Research, Livonia, MI; St Mary Mercy Hospital Department of Emergency Medicine, Livonia, MI; Michigan State University School of Osteopathic Medicine, East Lansing, MI; University of Michigan School of Medicine, Ann Arbor, MI.
Michigan State University School of Osteopathic Medicine, East Lansing, MI; College of Podiatric Medicine and Surgery, Des Moines University.
Spartan Med Res J. 2017 Aug 24;2(1):5959. doi: 10.51894/001c.5959.
Social isolation and comorbidities are likely to have a significant level of influence on the healthcare use patterns of geriatric patients with ongoing congestive heart failure (CHF)-related needs.
A retrospective study was conducted in a specialized emergency department (ED) with a sample of 286 geriatric CHF patients who initially received CHF-related care over a six-month period. Social isolation levels were assessed using a pre-existing four-point screening tool used in the study setting and composite comorbidity was gauged using the Charlson Comorbidity Index method. Subjects were categorized into either "less than 30-day readmission" or "greater than 30-day readmission/non-readmitted" sample subgroups. The setting was a single 304-bed community hospital with approximately 45,000 annual ED visits. The analytic sample was comprised of geriatric patients 65+ years of age with an ICD-9 code corresponding to CHF.
There were no statistically significant differences between earlier hospital readmission versus later/non-readmitted sample patients when grouped by age, race, gender or level of measured social isolation. However, composite comorbidity scores were significantly lower for patients in the >30-day/non-readmitted subgroup compared to earlier readmission patients.
These initial study results suggest that a larger proportion of CHF hospital readmissions may be more heavily influenced by clinical factors than social living arrangements. Future studies with larger samples and validated measures of social isolation are needed to inform the development and testing of programs for geriatric CHF patients striving to avoid unnecessary hospital readmissions and adverse health outcomes.
社会隔离和共病可能对有持续充血性心力衰竭（CHF）相关需求的老年患者的医疗使用模式产生重大影响。
在一个专门的急诊科进行了一项回顾性研究，样本为286名老年CHF患者，他们在六个月内最初接受了CHF相关护理。使用研究环境中预先存在的四点筛查工具评估社会隔离水平，并使用Charlson共病指数方法衡量综合共病情况。受试者被分为“30天内再入院”或“30天以上再入院/未再入院”样本亚组。研究地点是一家拥有304张床位的社区医院，每年约有45000人次急诊就诊。分析样本包括年龄在65岁及以上、ICD-9编码对应CHF的老年患者。
按年龄、种族、性别或测量的社会隔离水平分组时，早期医院再入院患者与后期/未再入院样本患者之间没有统计学上的显著差异。然而，与早期再入院患者相比，30天以上/未再入院亚组患者的综合共病评分显著更低。
这些初步研究结果表明，CHF医院再入院的较大比例可能受临床因素的影响大于社会生活安排。需要进行更大样本且社会隔离测量经过验证的未来研究，以为旨在避免老年CHF患者不必要的医院再入院和不良健康结局的项目的开发和测试提供信息。
