Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States of America.
Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States of America.
PLoS One. 2022 Jan 20;17(1):e0260664. doi: 10.1371/journal.pone.0260664. eCollection 2022.
Pneumonia and sepsis are among the most common causes of hospitalization in the United States and often result in discharges to a skilled nursing facility (SNF) for rehabilitation. We described the timing and most common causes of 30-day unplanned hospital readmission following an index hospitalization for pneumonia or sepsis.
This national retrospective cohort study included adults ≥65 years who were hospitalized for pneumonia or sepsis and were discharged to a SNF between July 1, 2012 and July 4, 2015. We quantified the ten most common 30-day unplanned readmission diagnoses and estimated the daily risk of first unplanned rehospitalization for four causes of readmission (circulatory, infectious, respiratory, and genitourinary). The index hospitalization was pneumonia for 92,153 SNF stays and sepsis for 452,254 SNF stays. Of these SNF stays, 20.9% and 25.9%, respectively, resulted in a 30-day unplanned readmission. Overall, septicemia was the single most common readmission diagnosis for residents with an index hospitalization for pneumonia (16.7% of 30-day readmissions) and sepsis (22.4% of 30-day readmissions). The mean time to unplanned readmission was approximately 14 days overall. Respiratory causes displayed the highest daily risk of rehospitalization following index hospitalizations for pneumonia, while circulatory and infectious causes had the highest daily risk of rehospitalization following index hospitalizations for sepsis. The day of highest risk for readmission occurred within two weeks of the index hospitalization discharge, but the readmission risk persisted across the 30-day follow-up.
Among older adults discharged to SNFs following a hospitalization for pneumonia or sepsis, hospital readmissions for infectious, circulatory, respiratory, and genitourinary causes occurred frequently throughout the 30-day post-discharge period. Our data suggests further study is needed, perhaps on the value of closer monitoring in SNFs post-hospital discharge and improved communication between hospitals and SNFs, to reduce the risk of potentially preventable hospital readmissions.
肺炎和败血症是美国最常见的住院原因之一，经常导致患者出院到康复护理机构（SNF）接受康复治疗。我们描述了因肺炎或败血症住院后 30 天内计划外再次住院的时间和最常见原因。
这是一项全国性回顾性队列研究，纳入了年龄≥65 岁、因肺炎或败血症住院并于 2012 年 7 月 1 日至 2015 年 7 月 4 日出院到 SNF 的患者。我们量化了 30 天内计划外再次住院的 10 种最常见诊断，并估计了四种再入院原因（循环系统、感染、呼吸系统和泌尿生殖系统）首次无计划再入院的日风险。索引住院为肺炎的 SNF 住院 92153 例，败血症的 SNF 住院 452254 例。这些 SNF 住院中，分别有 20.9%和 25.9%导致 30 天内计划外再次住院。总的来说，败血症是肺炎 SNF 住院患者（肺炎 30 天再入院的 16.7%）和败血症 SNF 住院患者（败血症 30 天再入院的 22.4%）的单一最常见再入院诊断。无计划再入院的平均时间约为 14 天。与肺炎索引住院相比，呼吸系统原因导致再住院的日风险最高，而与败血症索引住院相比，循环系统和感染原因导致再住院的日风险最高。再入院的最高风险日发生在索引住院出院后两周内，但再入院风险在 30 天随访期间持续存在。
在因肺炎或败血症住院后出院到 SNF 的老年人中，因感染、循环、呼吸和泌尿生殖系统原因导致的医院再次入院在出院后 30 天内经常发生。我们的数据表明，需要进一步研究，也许需要研究在 SNF 出院后更密切监测和医院与 SNF 之间更好沟通的价值，以降低潜在可预防的医院再入院的风险。
