Amritphale Amod, Fonarow Gregg C, Amritphale Nupur, Omar Bassam, Crook Errol D
Department of Internal Medicine, University Hospital, University of South Alabama, Mobile, Alabama, USA.
Ahmanson-UCLA Cardiomyopathy Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.
Intern Med J. 2023 Feb;53(2):262-270. doi: 10.1111/imj.15581. Epub 2022 Aug 9.
There are few studies looking into adult, all-cause and age-group-specific unplanned readmissions. The predictors of such unplanned readmissions for all inpatient encounters remain obscure.
To describe the incidence and factors associated with unplanned readmissions in all inpatient encounters in the United States.
The US Nationwide Readmission Database (NRD) is a representative sample of hospitalisations in the United States (from approximately 28 states) accounting for approximately 60% of the US population. All inpatient encounters during January-November 2017 in the NRD were evaluated for the rates, predictors and costs of unplanned 30 days readmissions for age groups 18-44 years, 45-64 years, 65-75 years and ≥75 years. Elective readmissions and those patients who died on their index hospitalisations were excluded. Weighted analysis was performed to obtain nationally representative data.
We identified 28 942 224 inpatient encounters with a total of 3 051 189 (10.5%) unplanned readmissions within 30 days. The age groups 18-44 years, 45-64 years, 65-74 years and ≥75 years had 7.0%, 12.0%, 11.7% and 12.3% readmissions respectively. Female gender, private insurance and elective admissions were negative predictors for readmissions. For the group aged 18-44 years, schizophrenia and diabetes mellitus complications were the most frequent primary diagnosis for readmissions, while in all older age groups septicaemia and heart failure were the most frequent primary diagnosis for readmissions.
Thirty-day unplanned readmissions are common in patients over age 45 years, leading to significant morbidity. Effective strategies for reducing unplanned readmission may help to improve quality of care, outcomes and higher value care.
很少有研究关注成人、全因及特定年龄组的非计划再入院情况。所有住院患者非计划再入院的预测因素仍不明确。
描述美国所有住院患者非计划再入院的发生率及相关因素。
美国全国再入院数据库（NRD）是美国住院治疗的代表性样本（来自约28个州），覆盖约60%的美国人口。对2017年1月至11月NRD中的所有住院患者进行评估，分析18 - 44岁、45 - 64岁、65 - 75岁和≥75岁年龄组非计划30天再入院的发生率、预测因素和费用。排除择期再入院患者以及在首次住院期间死亡的患者。进行加权分析以获得具有全国代表性的数据。
我们识别出28942224例住院患者，其中3051189例（10.5%）在30天内发生非计划再入院。18 - 44岁、45 - 64岁、65 - 74岁和≥75岁年龄组的再入院率分别为7.0%、12.0%、11.7%和12.3%。女性、私人保险和择期入院是再入院的负性预测因素。对于18 - 44岁年龄组，精神分裂症和糖尿病并发症是再入院最常见的主要诊断，而在所有老年年龄组中，败血症和心力衰竭是再入院最常见的主要诊断。
45岁以上患者30天非计划再入院情况常见，会导致显著的发病率。降低非计划再入院的有效策略可能有助于提高医疗质量、改善治疗结果并提供更高价值的医疗服务。
